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NPI Code Detail

MEDICARE: DR. DAVID LYNN FAIRBROOK MD

MEDICARE: DR. DAVID LYNN FAIRBROOK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0300XGeriatric Medicine (Internal Medicine) PhysicianMD00013192WA

General Provider Information

NPI Number : 1295707537
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID LYNN FAIRBROOK MD
Provider Business Mailing Address
First Line : PO BOX 3360
Second Line :
City : PORTLAND
State : OR
Zip : 97208-3360
Country : US
Telephone Number : 360-486-6508
Fax Number :
Provider Business Practice Location Address
First Line : 1450 NORTHWEST LN SE
Second Line :
City : LACEY
State : WA
Zip : 98503-6908
Country : US
Telephone Number : 360-491-4460
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2006
Last Update Date : 08/29/2013

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Directions to “ DR. DAVID LYNN FAIRBROOK MD” Practice Location

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