Individual
TRACY MARIE FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
935 HIGHLAND BLVD STE 2200, BOZEMAN, MT 59715-6915
(406) 414-5700
(406) 586-9671
Mailing address
915 HIGHLAND BLVD, BOZEMAN, MT 59715-6902
(406) 414-5000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9807
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0036278
—
MT
01
—
08174812
RAILROAD MEDICARE
MT
Enumeration date
09/13/2006
Last updated
04/09/2025
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