# ROBERT ANTHONY FAIRFAX

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1063408052
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA10003111 | WA | Yes |

## Other

- **Enumeration date:** 09/23/2005
- **Last updated:** 05/18/2021

## 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 | — |