Provider Demographics
NPI:1932376282
Name:FAIRGRIEVE, FABIOLA DUTES (MD JD)
Entity Type:Individual
Prefix:DR
First Name:FABIOLA
Middle Name:DUTES
Last Name:FAIRGRIEVE
Suffix:
Gender:F
Credentials:MD JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2836 SHENANDOAH RD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-1426
Mailing Address - Country:US
Mailing Address - Phone:386-561-8907
Mailing Address - Fax:
Practice Address - Street 1:2836 SHENANDOAH RD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-1426
Practice Address - Country:US
Practice Address - Phone:386-561-8907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 076925207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine