Healthcare Provider Details

I. General information

NPI: 1558758094
Provider Name (Legal Business Name): TOM PAUL FABISH LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 S JACKSON ST SUITE 206
DENVER CO
80210-3801
US

IV. Provider business mailing address

1776 S JACKSON ST SUITE 206
DENVER CO
80210-3801
US

V. Phone/Fax

Practice location:
  • Phone: 720-524-4718
  • Fax: 303-265-9439
Mailing address:
  • Phone: 720-524-4718
  • Fax: 303-265-9439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License NumberMT.0017222
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: