Provider Demographics
NPI:1376634972
Name:FABACHER, JEFFREY E (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:E
Last Name:FABACHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 2ND AVE N
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5756
Mailing Address - Country:US
Mailing Address - Phone:239-261-8188
Mailing Address - Fax:239-261-9144
Practice Address - Street 1:700 2ND AVE N
Practice Address - Street 2:SUITE 302
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5756
Practice Address - Country:US
Practice Address - Phone:239-261-8188
Practice Address - Fax:239-261-9144
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 00559282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE06805Medicare UPIN
FL11941ZMedicare PIN