Provider Demographics
NPI:1548449663
Name:ALBAALBAKI, FYSAL (MD)
Entity type:Individual
Prefix:DR
First Name:FYSAL
Middle Name:
Last Name:ALBAALBAKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2151
Mailing Address - Country:US
Mailing Address - Phone:817-339-8855
Mailing Address - Fax:817-339-8889
Practice Address - Street 1:508 SOUTH ADAMS,
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2151
Practice Address - Country:US
Practice Address - Phone:817-339-8855
Practice Address - Fax:817-339-8889
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9273207RN0300X
AZ40099207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX363766201Medicaid