Basic Information
| Provider Information | |||||||||
| NPI: | 1700871415 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FABER | ||||||||
| FirstName: | AVROHM | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5220 BELFORT RD | ||||||||
| Address2: | STE 130 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322566017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278675480 | ||||||||
| FaxNumber: | 8885079833 | ||||||||
| Practice Location | |||||||||
| Address1: | 5220 BELFORT RD | ||||||||
| Address2: | STE 130 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322566017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278675480 | ||||||||
| FaxNumber: | 8885079833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2005 | ||||||||
| LastUpdateDate: | 06/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | ME0026490 | FL | Y | Allopathic & Osteopathic Physicians | Surgery | 207NS0135X | ME0026490 | FL | N | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology | 2083P0011X | ME0026490 | FL | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Undersea and Hyperbaric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036668400 | 05 | FL | MEDICAID |