Individual
WALTER RAYMOND FAIRFAX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 625-4000
Mailing address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 625-4000
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
M11477
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000096870
BCBS PIN
MT
01
—
0011135
MDCD PIN
MT
01
—
105079600
MDCD PIN
WY
Enumeration date
01/18/2007
Last updated
04/16/2024
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