Individual
BRENT DAVID FARE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CCP
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-1548
Mailing address
7241 SW 13TH DR, PORTLAND, OR 97219-2073
(503) 319-9457
Taxonomy
Speciality
Code
Description
License number
State
242T00000X
Perfusionist
Primary
080013
OR
Other
Enumeration date
06/27/2020
Last updated
06/27/2020
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