Provider Demographics
NPI:1598089591
Name:FABACHER, DONALD WILTZ JR (M D)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:WILTZ
Last Name:FABACHER
Suffix:JR
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 231464
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70183-1464
Mailing Address - Country:US
Mailing Address - Phone:504-500-8125
Mailing Address - Fax:504-552-2433
Practice Address - Street 1:8231 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-4617
Practice Address - Country:US
Practice Address - Phone:504-500-8125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.205089207Q00000X
NE29012207Q00000X
IL036.139477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine