Provider Demographics
NPI:1811990450
Name:FABER, DAVID WAYNE (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:FABER
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 1:4400 S 700 E
Mailing Address - Street 2:STE 200
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3000
Mailing Address - Country:US
Mailing Address - Phone:801-264-4444
Mailing Address - Fax:801-281-2383
Practice Address - Street 1:4400 S 700 E
Practice Address - Street 2:STE 200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-3000
Practice Address - Country:US
Practice Address - Phone:801-264-4444
Practice Address - Fax:801-281-2383
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT337929-1205207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000101643Medicaid
UT87-0302621OtherGEHA
WY112671700Medicaid
UT87-0302621OtherMAILHANDLERS
UT1846444OtherCIGNA OPEN ACCESS PLUS
UT87-0302621OtherGREAT WEST HEALTHCARE
UT107008061101OtherIHC
UT87-0302621OtherCCN
UT1846444OtherCIGNA PPO
UT87-0302621OtherFIRST HEALTH
UT87-0302621OtherPEHP
UT180029059OtherRAILROAD MEDICARE
WY307586OtherBCBS OF WY
UT37854OtherPEHP
UT87-0302621OtherPEHP
UT87-0302621OtherCCN
UT180029059OtherRAILROAD MEDICARE
UTG03066Medicare UPIN
WYW307586Medicare PIN
UT87-0302621OtherGEHA