Individual
MATTHEW ALLYN FAGERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
500 SW RAMSEY AVE, GRANTS PASS, OR 97527
(541) 472-7000
Mailing address
2620 EAST BARNETT RD, SUITE H, MEDFORD, OR 97504
(541) 789-5250
(541) 789-5538
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
200540820
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
049337
—
OR
Enumeration date
03/05/2007
Last updated
06/18/2013
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