Provider Demographics
NPI:1528324118
Name:FAIRBANKS, CARSON L (MD)
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:L
Last Name:FAIRBANKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6301 HARRIS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4265
Mailing Address - Country:US
Mailing Address - Phone:817-433-3450
Mailing Address - Fax:817-294-6429
Practice Address - Street 1:5900 ALTAMESA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-5475
Practice Address - Country:US
Practice Address - Phone:817-854-9969
Practice Address - Fax:817-845-9965
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ7686207X00000X, 207XS0117X
AZ53703207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery