Individual
PATRICK HUGH FAIRLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
29000 CENTER RIDGE RD, WESTLAKE, OH 44145-5293
(440) 835-8000
Mailing address
26930 LAKE RD, BAY VILLAGE, OH 44140-2267
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35053640F
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0673016
—
OH
01
—
942460636247
CARESOURCE
OH
Enumeration date
05/27/2006
Last updated
07/08/2007
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