Individual
MR. BRENT WILLIAM FAIRCHILD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
025179
NY
363A00000X
Physician Assistant
25179
NY
Other
Enumeration date
10/25/2018
Last updated
07/03/2023
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