Provider Demographics
NPI:1134394117
Name:EKO, FREDERICK N (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:N
Last Name:EKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44651 VILLAGE CT STE 104
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3821
Mailing Address - Country:US
Mailing Address - Phone:760-249-2222
Mailing Address - Fax:760-237-2223
Practice Address - Street 1:44651 VILLAGE CT
Practice Address - Street 2:STE 104
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3821
Practice Address - Country:US
Practice Address - Phone:760-413-5544
Practice Address - Fax:760-237-2223
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1208732086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty