| NPI | 1578699039 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRANT R FAIRBANKS Medical Doctor 801-268-8838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: UT 1487731205) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2008-08-13 |