Fairbanks, Brent R

Fairbanks, Brent R is an individual health care provider with primary practice located at 1235 E Cherokee , Springfield MO 65804-2203. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Anesthesiologist Assistant, which is considered as his primary health care specialty. Fairbanks, Brent R can be contacted via phone (417) 820-2829.

Contact Information

Primary practice address
1235 E Cherokee Springfield MO 65804-2203
Phone: (417) 820-2829
Fax: (417) 820-8852
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Anesthesiologist Assistant 367H00000X 2012028957 Missouri

Profile Details

NPI number 1538418793
LBN Legal business name Fairbanks, Brent R
Credentials Associate of Arts (AA)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 4th, 2012
Last updated Feb 22nd, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538418793 NPPES
Missouri MEDICAID 1538418793
Missouri Other P01129106
Missouri Other 431560263

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