Provider Demographics
NPI:1033265418
Name:D BRUCE FABER DO PC
Entity Type:Organization
Organization Name:D BRUCE FABER DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:D
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:FABER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:970-255-1975
Mailing Address - Street 1:1894 MONUMENT CANYON DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507-9525
Mailing Address - Country:US
Mailing Address - Phone:970-255-1975
Mailing Address - Fax:970-255-1975
Practice Address - Street 1:1894 MONUMENT CANYON DR
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81507-9525
Practice Address - Country:US
Practice Address - Phone:970-255-1975
Practice Address - Fax:970-255-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41248207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA03702Medicare UPIN