Provider Demographics
NPI:1265592901
Name:LOREN L. FAABORG, MD, PC
Entity type:Organization
Organization Name:LOREN L. FAABORG, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAABORG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-974-3647
Mailing Address - Street 1:10503 W THUNDERBIRD BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3022
Mailing Address - Country:US
Mailing Address - Phone:623-974-3647
Mailing Address - Fax:623-977-0310
Practice Address - Street 1:10503 W THUNDERBIRD BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3022
Practice Address - Country:US
Practice Address - Phone:623-974-3647
Practice Address - Fax:623-977-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33356207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ974289Medicaid
AZ974289Medicaid
AZ106203Medicare PIN