Healthcare Provider Details

I. General information

NPI: 1245592484
Provider Name (Legal Business Name): VID FIKFAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 ALBERTA AVE
EL PASO TX
79905-2707
US

IV. Provider business mailing address

6550 FANNIN ST STE 2307
HOUSTON TX
77030-2723
US

V. Phone/Fax

Practice location:
  • Phone: 915-215-5300
  • Fax: 915-215-8606
Mailing address:
  • Phone: 832-472-6356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10044088
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberS2771
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: