Individual
DR. JUSTIN WALTER FAIRLESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1651 W ROSEDALE ST, FORT WORTH, TX 76104-7437
(817) 257-6633
Mailing address
TCU BOX 297085, FORT WORTH, TX 76129-0001
(817) 257-6633
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
N3638
TX
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
N3638
TX
Other
Enumeration date
08/28/2009
Last updated
12/12/2023
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