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General NPI Number Information
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NPI Number | 1619068574
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Entity Type | Organization
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Legal Business Name | GEORGE P. FEDOR, M.D., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 250 S GRAND AVE
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City | GLENDORA
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State | CA
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Zip | 91741-4218
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Country | US
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Telephone | 626-857-3140
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Fax |
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Provider Business Mailing Address
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Address Line | 1317 S DIAMOND BAR BLVD 4007
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City | DIAMOND BAR
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State | CA
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Zip | 91765-5679
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Country | US
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Telephone | 909-878-6665
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Fax | 909-595-3705
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGE PHILIP FEDOR
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Credential | M.D.
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Telephone | 323-346-7763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A52838
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License Number State | CA
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