Glenn Albert Fairall

NPI #1982169611 in Albany, Oregon

Provider Information

NPI Number: 1982169611
Entity Type: Individual
Name: Glenn Albert Fairall
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Technician/Technologist
Enumeration Date: Feb 6, 2019
Last Updated: Feb 6, 2019

Practice Location

Address: 2532 NW ASHLEY DR
City: Albany
State: Oregon
ZIP Code: 97321-1395
Phone: (541) 979-1019

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Technician/Technologist	156F00000X	Primary

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