Provider Demographics
NPI:1740376177
Name:SABOL, DANIEL JOHN (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOHN
Last Name:SABOL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2130 FARMINGTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-2123
Mailing Address - Country:US
Mailing Address - Phone:505-325-2323
Mailing Address - Fax:505-325-7172
Practice Address - Street 1:2130 FARMINGTON AVE STE A
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2123
Practice Address - Country:US
Practice Address - Phone:505-325-2323
Practice Address - Fax:505-325-7172
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA130105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10019838OtherLOVELACE
94683OtherPHP
NM004B23OtherBCBS
94683OtherPHP
10019838OtherLOVELACE
I36975Medicare UPIN