Healthcare Provider Details

I. General information

NPI: 1700871415
Provider Name (Legal Business Name): AVROHM WILLIAM FABER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 BELFORT RD STE 130
JACKSONVILLE FL
32256-6017
US

IV. Provider business mailing address

5220 BELFORT RD STE 130
JACKSONVILLE FL
32256-6017
US

V. Phone/Fax

Practice location:
  • Phone: 727-867-5480
  • Fax: 888-507-9833
Mailing address:
  • Phone: 727-867-5480
  • Fax: 888-507-9833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME0026490
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME0026490
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberME0026490
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: