Healthcare Provider Details

I. General information

NPI: 1962472993
Provider Name (Legal Business Name): FELIX G VLADIMIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 YAKIMA AVE STE 204
TACOMA WA
98405-5304
US

IV. Provider business mailing address

1802 YAKIMA AVE STE 204
TACOMA WA
98405-5304
US

V. Phone/Fax

Practice location:
  • Phone: 253-382-8540
  • Fax: 253-984-2049
Mailing address:
  • Phone: 253-382-8540
  • Fax: 253-984-2049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD60019977
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number220659
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD60019977
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMC-2932
License Number StateID
# 5
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number226002
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: