Individual
JOHN LAWRENCE FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4370 MEDICAL ARTS DR, SUITE 105, FLOWER MOUND, TX 75028-1712
(214) 394-4500
(214) 513-2059
Mailing address
3600 GASTON AVE, SUITE 1205, DALLAS, TX 75246-1800
(214) 692-8262
(214) 696-4190
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
J9018
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117289211
—
TX
05
—
117289212
—
TX
01
—
P01601410
RRMCR
TX
Enumeration date
09/01/2006
Last updated
01/31/2017
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