Healthcare Provider Details

I. General information

NPI: 1497027270
Provider Name (Legal Business Name): VILSON FELAU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AMPLIACION ADOLFO LOPEZ MATEUS S/N
REYNOSA TAMAULIPAS
88560
MX

IV. Provider business mailing address

1121 SANDPIPER AVE APT. # 29
MCALLEN TX
78504-3157
US

V. Phone/Fax

Practice location:
  • Phone: 956-784-4718
  • Fax:
Mailing address:
  • Phone: 956-784-4718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4558026
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: