Provider Demographics
NPI:1003974528
Name:FABRIC, ROBERT KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KEITH
Last Name:FABRIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 ISLAND BLVD
Mailing Address - Street 2:S-323
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 ISLAND BLVD
Practice Address - Street 2:S-323
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-4923
Practice Address - Country:US
Practice Address - Phone:305-792-4747
Practice Address - Fax:305-792-4748
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 12886208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery