Provider Demographics
NPI:1881615466
Name:FABRICANT, ROBERT NEAL (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NEAL
Last Name:FABRICANT
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 1:8319 SE RIVERS EDGE ST
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-1030
Mailing Address - Country:US
Mailing Address - Phone:949-632-8663
Mailing Address - Fax:
Practice Address - Street 1:8319 SE RIVERS EDGE ST
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-1030
Practice Address - Country:US
Practice Address - Phone:949-632-8663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30028207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G300280Medicaid
CAA44264Medicare UPIN
CA00G300280Medicare PIN
CA00G300280Medicaid