Individual
MARY E FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1783 15TH ST, DENVER, CO 80202-1888
(303) 532-1536
(303) 825-3397
Mailing address
1783 15TH ST, DENVER, CO 80202-1888
(303) 532-1536
(303) 825-3397
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
29115
CO
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
29115
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01291152
—
CO
Enumeration date
08/07/2006
Last updated
01/29/2019
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