Carolyn S Fairfax, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD16107 Issued in OR

Practice address

9605 Grand Ronde Rd
Grand Ronde, OR 97347-9712

Phone

(503) 879-2002

Fax

(503) 879-2071

NPI assigned

Nov 23, 2005

Last updated

Jun 7, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Confederated Tribes of Grand Ronde Community of Oregon Dba GR Health &

  • Community Health Clinic/Center
  • Grand Ronde, OR
  • NPI 1104164359
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623024000000",
    "number": "1407839384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9605 GRAND RONDE RD",
            "city": "GRAND RONDE",
            "state": "OR",
            "postal_code": "973479712",
            "telephone_number": "503-879-2002",
            "fax_number": "503-370-4237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9605 GRAND RONDE RD",
            "city": "GRAND RONDE",
            "state": "OR",
            "postal_code": "973479712",
            "telephone_number": "503-879-2002",
            "fax_number": "503-879-2071"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5050 Skyline Village Loop S",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973069490",
            "country_code": "US",
            "telephone_number": "503-391-1110",
            "fax_number": "503-370-4237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAIRFAX",
        "first_name": "CAROLYN",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-23",
        "last_updated": "2021-06-07",
        "certification_date": "2021-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD16107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "076393",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph Shane Cox
• Dorothy R De la Rosa, CDAC II
• Cyaandi Rhone Dove, D.P.M.
• Casey Eash, LPC, CADC I
• Nicole Marie Estrada, LMFT, LPC
• Troyce Fortune
• Amber Foster, CRM
• Shelly Rae Fox
• Jill Goodwin, LPC, MFT, ATR
• Taylor Ann Gustafson

• Family Medicine Physician in Grand Ronde, OR
• Providers in Grand Ronde, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.