Provider Demographics
NPI:1952512980
Name:FAIRFAX, LINDSAY (MD)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:FAIRFAX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10012 KENNERLY RD STE 406
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2197
Mailing Address - Country:US
Mailing Address - Phone:314-525-1224
Mailing Address - Fax:314-525-4957
Practice Address - Street 1:10012 KENNERLY RD STE 406
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2197
Practice Address - Country:US
Practice Address - Phone:314-525-1224
Practice Address - Fax:314-525-4957
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301115451208600000X
IL036140509208600000X
NC141098208600000X
IN01091194A208600000X
WI702722086S0102X
MO20220198502086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery