Provider Demographics
NPI:1346610052
Name:FREDERICK EKO MD INC
Entity Type:Organization
Organization Name:FREDERICK EKO MD INC
Other - Org Name:EKO PLASTIC SURGERY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:N
Authorized Official - Last Name:EKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-413-5544
Mailing Address - Street 1:PO BOX 2867
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92261-2867
Mailing Address - Country:US
Mailing Address - Phone:760-249-2222
Mailing Address - Fax:760-237-2223
Practice Address - Street 1:44651 VILLAGE CT STE 104
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3821
Practice Address - Country:US
Practice Address - Phone:760-249-2222
Practice Address - Fax:760-237-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA120873208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty