Provider Demographics
NPI:1023211265
Name:VICTOR M. FERMO JR., MD
Entity Type:Organization
Organization Name:VICTOR M. FERMO JR., MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:MENDOZA
Authorized Official - Last Name:FERMO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:409-727-7979
Mailing Address - Street 1:405 S MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-7430
Mailing Address - Country:US
Mailing Address - Phone:409-727-7979
Mailing Address - Fax:409-727-5459
Practice Address - Street 1:405 S MEMORIAL FWY
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-7430
Practice Address - Country:US
Practice Address - Phone:409-727-7979
Practice Address - Fax:409-727-5459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF26552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ13QOtherBLUE CROSS / BLUE SHIELD
TX00J13QMedicare Oscar/Certification
TX00J13QMedicare PIN
TXB87774Medicare UPIN