Provider Demographics
NPI:1104898915
Name:FAY, DAVID L
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:FAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 CHAMPA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2529
Mailing Address - Country:US
Mailing Address - Phone:303-312-9807
Mailing Address - Fax:303-312-9807
Practice Address - Street 1:2130 STOUT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2827
Practice Address - Country:US
Practice Address - Phone:303-293-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42443207Q00000X
CO55525207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33339200Medicaid
CO85680052Medicaid
WI1104898915Medicaid
WI33339200Medicaid
WI1104898915Medicaid