Healthcare Provider Details

I. General information

NPI: 1073911236
Provider Name (Legal Business Name): GULFCARE, LLC DBA FEDOK PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2014
Last Update Date: 08/14/2017
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 AVENUE
FOLEY AL
36535
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 TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number15147
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number15147
License Number StateAL

VIII. Authorized Official

Name: FREDERICK FEDOK
Title or Position: OWNER PRESIDENT
Credential: MD
Phone: 251-943-6003