Organization
THE CLINIC AT PANORAMA CITY,PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID L FAIRBROOK MD (OWNER)
(360) 491-4460
Entity
Organization
Contact information
Practice address
4044 15TH LN SE, SUITE A, LACEY, WA 98503
(360) 491-4460
(360) 491-3090
Mailing address
4044 15TH LN SE, SUITE A, LACEY, WA 98503
(360) 491-4460
(360) 491-3090
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
04/20/2007
Last updated
09/11/2025
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