Individual
ROBERT KENNETH FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
504 6TH ST, LEWISTON, ID 83501-2439
(208) 799-5600
(208) 799-5755
Mailing address
PO BOX 239, LEWISTON, ID 83501-0239
(208) 799-5600
(208) 799-5755
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
MD00037655
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010032648
BLUE SHIELD OF IDAHO
—
01
—
0144615
LABOR & INDUSTRIES
WA
01
—
3070FA
ASURIS NW HEALTH
WA
01
—
5034131
AETNA
—
05
—
805949200
—
ID
05
—
8243958
—
WA
01
—
920006292
RAILROAD MEDICARE
—
01
—
K0716
BLUE CROSS OF IDAHO
—
Enumeration date
09/26/2005
Last updated
08/05/2024
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