Healthcare Provider Details

I. General information

NPI: 1760449656
Provider Name (Legal Business Name): FRED G FEDOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E FERN AVE
FOLEY AL
36535-2806
US

IV. Provider business mailing address

113 E FERN AVE
FOLEY AL
36535-2806
US

V. Phone/Fax

Practice location:
  • Phone: 251-943-6003
  • Fax: 251-943-2429
Mailing address:
  • Phone: 251-943-6003
  • Fax: 251-943-2429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD028333E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number15147
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number15147
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: