Provider Demographics
NPI:1407846009
Name:FAIRBAIRN, DOUGLAS AUMILLER (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:AUMILLER
Last Name:FAIRBAIRN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1978 S GARRISON ST
Mailing Address - Street 2:101
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-2282
Mailing Address - Country:US
Mailing Address - Phone:303-988-1559
Mailing Address - Fax:303-988-1603
Practice Address - Street 1:6816 OTIS ST
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-4067
Practice Address - Country:US
Practice Address - Phone:303-420-7724
Practice Address - Fax:303-420-9349
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24649207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01246495Medicaid
CO01246495Medicaid
COC800853Medicare PIN