Individual
BRAIDEN CLARK FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
349 E CORONADO RD, PHOENIX, AZ 85004-1525
(602) 266-5678
Mailing address
253 N PIEDRA, MESA, AZ 85207-7561
(480) 721-1784
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8690
AZ
Other
Enumeration date
03/05/2021
Last updated
02/24/2025
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