Provider Demographics
NPI:1366458408
Name:FEDOSKY, ALLAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:L
Last Name:FEDOSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 5008
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-5008
Mailing Address - Country:US
Mailing Address - Phone:850-897-1824
Mailing Address - Fax:850-897-1827
Practice Address - Street 1:4554 E HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-9755
Practice Address - Country:US
Practice Address - Phone:850-897-1824
Practice Address - Fax:850-897-1827
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2012-05-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GUME0029230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE23009Medicare UPIN
FL72451Medicare PIN
FL08215ZMedicare Oscar/Certification