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Individual

CAROLYN S FAIRFAX

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
9605 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2002
(503) 879-2071
Mailing address
9605 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2002
(503) 370-4237

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD16107
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
076393
OR
Enumeration date
11/23/2005
Last updated
06/07/2021
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