=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841272549
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIAN FEIOCK M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2005
-----------------------------------------------------
Last Update Date | 11/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4790 BARKLEY CIR BLDG A
-----------------------------------------------------
City | FT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33907-7543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-275-8882
-----------------------------------------------------
Fax | 239-939-1330
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4790 BARKLEY CIR BLDG A
-----------------------------------------------------
City | FT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33907-7543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-275-8882
-----------------------------------------------------
Fax | 239-939-1330
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | FLME0061261
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------