Provider Demographics
NPI:1548083884
Name:FAGERLIE, CHRIS DAVID
Entity type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:DAVID
Last Name:FAGERLIE
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 1:27410 N 66TH LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-7526
Mailing Address - Country:US
Mailing Address - Phone:602-628-6482
Mailing Address - Fax:
Practice Address - Street 1:27410 N 66TH LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-7526
Practice Address - Country:US
Practice Address - Phone:602-628-6482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program