Provider Demographics
NPI:1427093111
Name:FABEC, SALLY LINDA (MD)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:LINDA
Last Name:FABEC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 W MAIN ST
Mailing Address - Street 2:STE 11
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2604
Mailing Address - Country:US
Mailing Address - Phone:719-846-4433
Mailing Address - Fax:719-846-9500
Practice Address - Street 1:134 W MAIN ST
Practice Address - Street 2:SUITE 11
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2604
Practice Address - Country:US
Practice Address - Phone:719-846-4433
Practice Address - Fax:719-846-9500
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20742207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
010014335OtherPALMETTO GBA
CO01207422Medicaid
010358000OtherBLACK LUNG
010358000OtherBLACK LUNG
COC533778Medicare ID - Type Unspecified