Provider Demographics
NPI:1902170814
Name:FREDERICK F LYKES, M D P A
Entity Type:Organization
Organization Name:FREDERICK F LYKES, M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:F
Authorized Official - Last Name:LYKES
Authorized Official - Suffix:
Authorized Official - Credentials:M D P A
Authorized Official - Phone:361-575-8203
Mailing Address - Street 1:303 E AIRLINE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3908
Mailing Address - Country:US
Mailing Address - Phone:361-575-8203
Mailing Address - Fax:361-575-8190
Practice Address - Street 1:303 E AIRLINE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3908
Practice Address - Country:US
Practice Address - Phone:361-575-8203
Practice Address - Fax:361-575-8190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD3550261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB24552Medicare UPIN