Provider Demographics
NPI:1780227918
Name:FAIRBANKS MEDICAL GROUP
Entity Type:Organization
Organization Name:FAIRBANKS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARTER
Authorized Official - Middle Name:H
Authorized Official - Last Name:SIGMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-255-1969
Mailing Address - Street 1:PO BOX 9227
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-4227
Mailing Address - Country:US
Mailing Address - Phone:858-255-1969
Mailing Address - Fax:858-759-6729
Practice Address - Street 1:16089 SAN DIEGUITO RD
Practice Address - Street 2:H102
Practice Address - City:RANCHO SANTA FE
Practice Address - State:CA
Practice Address - Zip Code:92067
Practice Address - Country:US
Practice Address - Phone:858-255-1969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty