Organization
VALLEY DERMATOLOGY CLINIC,S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN WILLIAM FABER M.D. (PRESIDENT)
(920) 734-6880
Entity
Organization
Contact information
Practice address
412 E LONGVIEW DR, APPLETON, WI 54911-2145
(920) 734-6880
(920) 734-8867
Mailing address
412 E LONGVIEW DR, APPLETON, WI 54911-2145
(920) 734-6880
(920) 734-8867
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31238800
—
WI
Enumeration date
05/09/2007
Last updated
08/22/2020
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