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NPI Code Detail

MEDICARE: DR. LAURA CRUMP FAIRBANKS MD

MEDICARE: DR. LAURA CRUMP FAIRBANKS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician304116LA

General Provider Information

NPI Number : 1932200144
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAURA CRUMP FAIRBANKS MD
Provider Business Mailing Address
First Line : PO BOX 1288
Second Line :
City : WINNFIELD
State : LA
Zip : 71483-1288
Country : US
Telephone Number : 318-648-0375
Fax Number : 318-648-0378
Provider Business Practice Location Address
First Line : 340 WEBB SMITH DR
Second Line :
City : COLFAX
State : LA
Zip : 71417-1910
Country : US
Telephone Number : 318-627-5021
Fax Number : 318-627-5999
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2006
Last Update Date : 01/12/2017

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