Provider Demographics
NPI:1902501331
Name:FAIR, RAIJON
Entity Type:Individual
Prefix:
First Name:RAIJON
Middle Name:
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 1:2444 OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-6211
Mailing Address - Country:US
Mailing Address - Phone:313-384-4053
Mailing Address - Fax:
Practice Address - Street 1:2444 OAKRIDGE DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-6211
Practice Address - Country:US
Practice Address - Phone:313-384-4053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker