Individual
SALLY LINDA FABEC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
134 W MAIN ST, SUITE 11, TRINIDAD, CO 81082-2604
(719) 846-4433
(719) 846-9500
Mailing address
134 W MAIN ST, STE 11, TRINIDAD, CO 81082-2604
(719) 846-4433
(719) 846-9500
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20742
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010014335
PALMETTO GBA
—
01
—
010358000
BLACK LUNG
—
05
—
01207422
—
CO
Enumeration date
06/18/2006
Last updated
03/02/2012
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