Healthcare Provider Details

I. General information

NPI: 1023049418
Provider Name (Legal Business Name): DANIEL REY FABER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 RIVER PARK DR #200
PROVO UT
84604-5764
US

IV. Provider business mailing address

280 RIVER PARK DR #200
PROVO UT
84604-5764
US

V. Phone/Fax

Practice location:
  • Phone: 801-223-4860
  • Fax: 801-371-8993
Mailing address:
  • Phone: 801-223-4860
  • Fax: 801-371-8993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME166876
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number1802048905
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number1802048905
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number180204-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: