Organization
FAIRFAX MEDICAL CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS FREDERICK GILLES MD (PHYSICIAN)
(507) 426-7228
Entity
Organization
Contact information
Practice address
300 PARK ST S, FAIRFAX, MN 55332-3153
(507) 426-7228
(507) 426-8257
Mailing address
PO BOX 529, 300 SOUTH PARK ST, FAIRFAX, MN 55332-0529
(507) 426-7228
(507) 426-8257
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0105551
MEDICA
—
01
—
1013965
PREFERRED ONE
—
01
—
109697
U-CARE
—
01
—
47164GI
BCBS
MN
01
—
773742
WORLD INS
—
01
—
HP21655
HEALTH PARTNERS
—
Enumeration date
09/19/2005
Last updated
04/20/2008
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