Organization
GRANT A. FAIRBANKS, MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRANT A FAIRBANKS (PROVIDER)
(801) 701-8688
Entity
Organization
Contact information
Practice address
520 MEDICAL DR, SUITE 210, BOUNTIFUL, UT 84010-4968
(801) 268-8838
Mailing address
PO BOX 1071, BOUNTIFUL, UT 84011-1071
(801) 701-8688
(801) 701-8689
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
2744901205
UT
Other
Enumeration date
07/20/2010
Last updated
11/20/2015
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