Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD028333E | PA |
Y | 207YS0123X | Facial Plastic Surgeon | 15147 | AL |
NPI | 1760449656 |
---|---|
Provider Name | Fred G Fedok |
First Address | Foley, AL 36535-2806 |
Second Address | Foley, AL 36535-2806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 22/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0011684000002 | (05) | PA |
A89747 | (02) | PA |