Most Relevant Information
Provider Data
| NPI Number: | 1003202847 |
| Provider Name: | SHAN R FAIRBANKS D.O. |
| Entity Type: | Individual |
| Taxonomy Code: | 207Q00000X |
| Specialty: | Family Medicine |
| License Number: | 0102204926 |
Most Important Dates
| Enumeration Date: | 04/08/2015 |
| Last Updated: | 06/16/2021 |
Provider Practice Location
118 BROAD ST
DUBLIN
VA
240843211
Practice Location Phone/Fax
| Phone: | 5406748805 |
| Fax: | 5406748670 |
Provider Mailing Location
213 S JEFFERSON ST STE 625
ROANOKE
VA
240111713
Provider Mailing Phone/Fax
| Phone: | 5402245516 |
| Fax: | 5402245684 |
Suggested EMR
Family Practice EMR