Active NPI
Allan L. Fedosky, M.D.
- Family Medicine Physician
- Niceville, FL
National Provider Identifier
1366458408
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- ME0029230
- Practice address
- 4554 E Highway 20
Niceville, FL 32578-9755 - Phone
- (850) 897-1824
- Fax
- (850) 897-1827
- NPI assigned
- Jul 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | ME0029230 | GU | Primary |
Addresses
Primary practice location
4554 E Highway 20
Niceville, FL 32578-9755
Mailing address
PO Box 5008
Niceville, FL 32578-5008
Phone (850) 897-1824
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME0029230 | GU | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335830400000",
"number": "1366458408",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5008",
"city": "NICEVILLE",
"state": "FL",
"postal_code": "325785008",
"telephone_number": "850-897-1824",
"fax_number": "850-897-1827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4554 E HIGHWAY 20",
"city": "NICEVILLE",
"state": "FL",
"postal_code": "325789755",
"telephone_number": "850-897-1824",
"fax_number": "850-897-1827"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEDOSKY",
"first_name": "ALLAN",
"middle_name": "L.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-31",
"last_updated": "2012-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GU",
"license": "ME0029230",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Niceville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.