Individual
DAVID W FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
203 HOSPITAL DR, RATON, NM 87740-2012
(575) 445-7720
(575) 445-7737
Mailing address
203 HOSPITAL DR, RATON, NM 87740-2012
(575) 445-7720
(575) 383-3332
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
16369
WV
207P00000X
Emergency Medicine Physician
6372524-1205
UT
207P00000X
Emergency Medicine Physician
MD2022-0625
NM
207Q00000X
Family Medicine Physician
Primary
6372524-1205
UT
207Q00000X
Family Medicine Physician
MD2022-0625
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810005265
—
WV
05
—
87155028
—
NM
Enumeration date
09/06/2006
Last updated
04/30/2024
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