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General NPI Number Information
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NPI Number | 1952512980
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Entity Type | Individual
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Provider Name | LINDSAY FAIRFAX MD
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/08/2024
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Provider Practice Location Address
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Address Line | 10012 KENNERLY RD STE 406
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2197
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Country | US
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Telephone | 314-525-1224
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Fax | 314-525-4957
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Provider Business Mailing Address
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Address Line | 10012 KENNERLY RD STE 406
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2197
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Country | US
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Telephone | 314-525-1224
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Fax | 314-525-4957
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301115451
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036140509
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 141098
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 01091194A
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License Number State | IN
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Taxonomy #5
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 70272
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License Number State | WI
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Taxonomy #6
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 2022019850
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License Number State | MO
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