Provider Demographics
NPI:1578994372
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:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:FABIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:239-949-0742
Mailing Address - Street 1:26800 S TAMIAMI TRL
Mailing Address - Street 2:#310
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-4349
Mailing Address - Country:US
Mailing Address - Phone:239-949-0742
Mailing Address - Fax:239-949-0768
Practice Address - Street 1:26800 S TAMIAMI TRL
Practice Address - Street 2:#310
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4349
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:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM75652174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty