Provider Demographics
NPI:1093983884
Name:BRIAN G. FABIAN MD PA
Entity Type:Organization
Organization Name:BRIAN G. FABIAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:FABIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-949-0742
Mailing Address - Street 1:26800 S TAMIAMI TRL STE 310
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-4348
Mailing Address - Country:US
Mailing Address - Phone:239-949-0742
Mailing Address - Fax:239-949-0768
Practice Address - Street 1:26800 S TAMIAMI TRL STE 310
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4348
Practice Address - Country:US
Practice Address - Phone:239-949-0742
Practice Address - Fax:239-949-0768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75652207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43327AMedicare UPIN