Provider Demographics
NPI:1073911236
Name:GULFCARE, LLC DBA FEDOK PLASTIC SURGERY
Entity Type:Organization
Organization Name:GULFCARE, LLC DBA FEDOK PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-943-6003
Mailing Address - Street 1:113 E. FERN AVENUE
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535
Mailing Address - Country:US
Mailing Address - Phone:251-943-6003
Mailing Address - Fax:251-943-2429
Practice Address - Street 1:113 E FERN AVE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2806
Practice Address - Country:US
Practice Address - Phone:251-943-6003
Practice Address - Fax:251-943-2429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15147207YS0123X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty