Individual
ERICA A. FAIRCLOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D., P.C.
Contact information
Practice address
3970 SOUTH 700 EAST, SUITE 14, SALT LAKE CITY, UT 84107
(801) 261-3605
(801) 262-9142
Mailing address
3970 SOUTH 700 EAST, SUITE 14, SALT LAKE CITY, UT 84107
(801) 261-3605
(801) 262-9142
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
7256620-1205
UT
207V00000X
Obstetrics & Gynecology Physician
81764
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689849523
—
UT
01
—
81764
TRAINING PERMIT
—
Enumeration date
04/22/2008
Last updated
06/08/2021
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