Individual
JOHN BRADFORD FASANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
509 SE RIVERSIDE DR, SUITE 206, STUART, FL 34994-2579
(772) 221-9111
Mailing address
509 SE RIVERSIDE DR, SUITE 206, STUART, FL 34994-2579
(772) 221-9111
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
61260
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
374249100
—
FL
Enumeration date
08/10/2006
Last updated
07/08/2007
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