Healthcare Provider Details

I. General information

NPI: 1245362763
Provider Name (Legal Business Name): BRIAN GEORGE FABIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SAN PABLO RD S
JACKSONVILLE FL
32224-1865
US

IV. Provider business mailing address

4500 SAN PABLO RD S
JACKSONVILLE FL
32224-1865
US

V. Phone/Fax

Practice location:
  • Phone: 904-953-2000
  • Fax: 239-949-0768
Mailing address:
  • Phone: 904-953-2000
  • Fax: 239-949-0768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME75652
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: