Individual
WALTER RAYMOND FAIRFAX
Active
Individual
WALTER RAYMOND FAIRFAX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
Update your record
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