Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A80244 | CA |
N | 208600000X | Surgeon | A80244 | CA |
Y | 2086S0120X | Pediatric Surgery | A80244 | CA |
NPI | 1407010556 |
---|---|
Provider Name | Dr. Timothy Joseph Fairbanks |
First Address | San Diego, CA 92123-4802 |
Second Address | San Diego, CA 92123-2778 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2008 |
Last Update Date | 08/12/2011 |