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General NPI Number Information
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NPI Number | 1578994372
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Entity Type | Organization
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Legal Business Name | BRIAN G. FABIAN MD PA
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Dates
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Enumeration Date | 12/03/2013
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Last Update Date | 12/03/2013
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Provider Practice Location Address
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Address Line | 26800 S TAMIAMI TRL #310
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-4349
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Country | US
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Telephone | 239-949-0742
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Fax | 239-949-0768
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Provider Business Mailing Address
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Address Line | 26800 S TAMIAMI TRL #310
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-4349
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Country | US
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Telephone | 239-949-0742
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Fax | 239-949-0768
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. LUCY FABIAN
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Credential | RN
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Telephone | 239-949-0742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | M75652
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License Number State | FL
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