Provider Demographics
NPI:1497928972
Name:FABIAN, MATTHEW W (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:W
Last Name:FABIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2926
Mailing Address - Country:US
Mailing Address - Phone:641-494-5400
Mailing Address - Fax:641-494-5403
Practice Address - Street 1:250 S CRESCENT DR
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2926
Practice Address - Country:US
Practice Address - Phone:641-494-5260
Practice Address - Fax:641-494-5267
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN50500208600000X
ND10849208600000X
IA5178208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN713538Medicare PIN
NDP00627354Medicare PIN
MN020003052Medicare PIN
MN020002900Medicare PIN