Individual
DR. GRANT R FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1151 E 3900 S, SUITE B110, SALT LAKE CITY, UT 84124-1216
(801) 268-8838
(801) 268-8264
Mailing address
1151 E 3900 S, SUITE B110, SALT LAKE CITY, UT 84124-1216
(801) 268-8838
(801) 268-8264
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
1487731205
UT
Other
Enumeration date
02/05/2007
Last updated
01/04/2013
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