=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821419441
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL HOKE FELLERS JR. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2013
-----------------------------------------------------
Last Update Date | 12/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19195 SCENIC HIGHWAY 98
-----------------------------------------------------
City | FAIRHOPE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36532-6837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-928-1929
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19195 SCENIC HIGHWAY 98
-----------------------------------------------------
City | FAIRHOPE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36532-6837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-928-1929
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | MD.5764
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------