Provider Demographics
NPI:1710018098
Name:FAIR, GARY ALLAN
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ALLAN
Last Name:FAIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4774 S ESTES ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80123-1860
Mailing Address - Country:US
Mailing Address - Phone:303-904-8876
Mailing Address - Fax:
Practice Address - Street 1:4774 S ESTES ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80123-1860
Practice Address - Country:US
Practice Address - Phone:303-904-8876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health