| Entity Name: | BRYAN D FREDRICK, MD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 01 Jun 2010 (15 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | L10000058375 |
| FEI/EIN Number | 272758410 |
| Address: | 1409 S WATERVIEW DRIVE, INVERNESS, FL, 34450, US |
| Mail Address: | P O BOX 609, INVERNESS, FL, 34451, US |
| ZIP code: | 34450 |
| County: | Citrus |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801106257 | 2010-10-19 | 2010-10-19 | PO BOX 609, INVERNESS, FL, 344510609, US | 1409 S WATERVIEW DR, INVERNESS, FL, 344503585, US | |||||||||||||||||||
|
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| Phone | +1 352-725-6945 |
| Phone | +1 352-726-9457 |
Authorized person
| Name | BRYAN D FREDRICK |
| Role | OWNER |
| Phone | 3527269457 |
Taxonomy
| Taxonomy Code | 207P00000X - Emergency Medicine Physician |
| License Number | ME31083 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| FREDRICK BRYAN D | Agent | 1409 S WATERVIEW DRIVE, INVERNESS, FL, 34450 |
| Name | Role | Address |
|---|---|---|
| FREDRICK BRYAN D | Managing Member | 1409 S WATERVIEW DRIVE, INVERNESS, FL, 34450 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2011-03-03 | 1409 S WATERVIEW DRIVE, INVERNESS, FL 34450 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-03-06 |
| ANNUAL REPORT | 2015-02-13 |
| ANNUAL REPORT | 2014-02-11 |
| ANNUAL REPORT | 2013-03-19 |
| ANNUAL REPORT | 2012-02-19 |
| ANNUAL REPORT | 2011-03-03 |
| ADDRESS CHANGE | 2010-12-10 |
| Florida Limited Liability | 2010-06-01 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
