Provider Demographics
NPI:1225063902
Name:FYFE, ALISTAIR IAN (MD PHD)
Entity Type:Individual
Prefix:
First Name:ALISTAIR
Middle Name:IAN
Last Name:FYFE
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:SUITE C-655
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2505
Mailing Address - Country:US
Mailing Address - Phone:972-566-8474
Mailing Address - Fax:972-566-8475
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE C-655
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-566-8474
Practice Address - Fax:972-566-8475
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8750207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A509680OtherMEDICAL PPIN#
CAWA50968AMedicare ID - Type UnspecifiedPPIN #
CAG00072Medicare UPIN
TXTXB163328Medicare PIN
CAWA50968BMedicare ID - Type UnspecifiedPPIN #