Provider Demographics
NPI:1265724470
Name:FAABORG, DANIEL LOREN (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LOREN
Last Name:FAABORG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 12TH AVE N
Mailing Address - Street 2:STE 160W
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7508
Mailing Address - Country:US
Mailing Address - Phone:406-237-5400
Mailing Address - Fax:
Practice Address - Street 1:2900 12TH AVE N STE 500E
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7500
Practice Address - Country:US
Practice Address - Phone:406-237-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT58501208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1265724470Medicaid