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NPI Code Detail

MEDICARE: CAROLYN S FAIRFAX MD

MEDICARE: CAROLYN S FAIRFAX 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
1207Q00000XFamily Medicine PhysicianMD16107OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407839384
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN S FAIRFAX MD
Provider Business Mailing Address
First Line : 9605 GRAND RONDE RD
Second Line :
City : GRAND RONDE
State : OR
Zip : 97347-9712
Country : US
Telephone Number : 503-879-2002
Fax Number : 503-370-4237
Provider Business Practice Location Address
First Line : 9605 GRAND RONDE RD
Second Line :
City : GRAND RONDE
State : OR
Zip : 97347-9712
Country : US
Telephone Number : 503-879-2002
Fax Number : 503-879-2071
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2005
Last Update Date : 06/07/2021

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Directions to “ CAROLYN S FAIRFAX MD” Practice Location

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