Provider Demographics
NPI:1700092145
Name:FAES, DEBBY JEAN (PA C)
Entity Type:Individual
Prefix:MS
First Name:DEBBY
Middle Name:JEAN
Last Name:FAES
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:DEBBY
Other - Middle Name:
Other - Last Name:FICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5025 STUART ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2925
Mailing Address - Country:US
Mailing Address - Phone:303-458-5906
Mailing Address - Fax:
Practice Address - Street 1:3655 LUTHERAN PARKWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6011
Practice Address - Country:US
Practice Address - Phone:720-284-3700
Practice Address - Fax:303-467-0525
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO426208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41429869Medicaid