Provider Demographics
NPI:1033484506
Name:FAIRHURST, MARGARET SARA (DO)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:SARA
Last Name:FAIRHURST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:541-732-7960
Mailing Address - Fax:
Practice Address - Street 1:1698 E MCANDREWS RD STE 400
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5590
Practice Address - Country:US
Practice Address - Phone:541-732-7960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-17
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO180852207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine