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General NPI Number Information
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NPI Number | 1649585753
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Entity Type | Individual
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Provider Name | JORDAN FABRIKANT D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/12/2010
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 921 TOWN CENTER DR
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City | ORANGE CITY
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State | FL
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Zip | 32763-8311
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Country | US
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Telephone | 386-218-1180
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Fax | 386-218-0950
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Provider Business Mailing Address
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Address Line | 900 VILLAGE SQUARE XING STE 290
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4552
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | OS11753
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | OS11753
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License Number State | FL
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