Provider Demographics
NPI:1356542971
Name:SALLY L. FABEC, M. D.
Entity type:Organization
Organization Name:SALLY L. FABEC, M. D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:LINDA
Authorized Official - Last Name:FABEC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-846-4433
Mailing Address - Street 1:328 S BONAVENTURE AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2086
Mailing Address - Country:US
Mailing Address - Phone:719-846-4433
Mailing Address - Fax:719-846-8350
Practice Address - Street 1:328 S BONAVENTURE AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2086
Practice Address - Country:US
Practice Address - Phone:719-846-4433
Practice Address - Fax:719-846-8350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty