1225347446 NPI number — JULIAN FABRY, PH.D., P.C.

Table of content: STEPHANIE LI VUONG D.O (NPI 1184164725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225347446 NPI number — JULIAN FABRY, PH.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JULIAN FABRY, PH.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225347446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5014 DAVENPORT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68132-2928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-551-7092
Provider Business Mailing Address Fax Number:
402-551-7092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5002 DODGE ST
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68132-2906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-551-7092
Provider Business Practice Location Address Fax Number:
402-551-7092
Provider Enumeration Date:
10/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
FABRY
Authorized Official First Name:
JULIAN
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
402-551-7092

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  94 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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