Provider Demographics
NPI:1700871415
Name:FABER, AVROHM WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:AVROHM
Middle Name:WILLIAM
Last Name:FABER
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 1:5220 BELFORT RD
Mailing Address - Street 2:STE 130
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6017
Mailing Address - Country:US
Mailing Address - Phone:727-867-5480
Mailing Address - Fax:888-507-9833
Practice Address - Street 1:5220 BELFORT RD
Practice Address - Street 2:STE 130
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6017
Practice Address - Country:US
Practice Address - Phone:727-867-5480
Practice Address - Fax:888-507-9833
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0026490208600000X, 207NS0135X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036668400Medicaid
FL64387ZMedicare PIN
FL036668400Medicaid