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General NPI Number Information
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NPI Number | 1932376282
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Entity Type | Individual
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Provider Name | FABIOLA DUTES FAIRGRIEVE M.D. J.D.
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Gender | Female
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 109 W WALL ST
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City | FROSTPROOF
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State | FL
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Zip | 33843-2043
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Country | US
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Telephone | 866-234-8534
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Fax |
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Provider Business Mailing Address
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Address Line | 47 5TH ST NW
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4672
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Country | US
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Telephone | 866-234-8534
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME76925
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License Number State | FL
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