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Individual
ROBERT ANTHONY FAIRFAX
Active
Individual
ROBERT ANTHONY FAIRFAX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10003111
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010142789
BLUE SHIELD OF IDAHO
—
01
—
0166417
LABOR & INDUSTRIES
WA
01
—
7628FA
ASURIS NW HEALTH
WA
05
—
806204300
—
ID
05
—
8323370
—
WA
01
—
970030113
RAILROAD MEDICARE
—
Enumeration date
09/23/2005
Last updated
05/18/2021
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