Provider Demographics
NPI:1649585753
Name:FABRIKANT, JORDAN (DO)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:FABRIKANT
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 1:1907 BOISE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4291
Mailing Address - Country:US
Mailing Address - Phone:970-682-3377
Mailing Address - Fax:970-682-3340
Practice Address - Street 1:1907 BOISE AVE STE 3
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4291
Practice Address - Country:US
Practice Address - Phone:970-682-3377
Practice Address - Fax:970-683-3340
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13142207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology