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Individual

MR. BRENT WILLIAM FAIRCHILD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
1081 BRIGHT STREAM WAY, WEBSTER, NY 14580
(585) 410-0678
Mailing address
1081 BRIGHT STREAM WAY, WEBSTER, NY 14580
(585) 410-0678

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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