Individual
DR. JOHN H FAIRBANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
107 FRONT ST, SUITE 2134, VIDALIA, LA 71373-2836
(318) 336-2212
(318) 336-6067
Mailing address
107 FRONT ST, SUITE 2134, VIDALIA, LA 71373-2836
(318) 336-2212
(318) 336-6067
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
15703
MS
207X00000X
Orthopaedic Surgery Physician
Primary
MD017268
LA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
MD.017268
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119142
—
MS
05
—
1384101
—
LA
Enumeration date
07/18/2006
Last updated
07/20/2023
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