Individual
WAYNE FAGIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
460 13TH ST NE, SALEM, OR 97301-2650
(503) 371-7655
Mailing address
460 13TH ST NE, SALEM, OR 97301-2650
(503) 371-7655
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
6031
OR
Other
Enumeration date
10/23/2006
Last updated
07/08/2007
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