Provider Demographics
NPI:1417984527
Name:FERMO, VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:FERMO
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 1:405 S MEMORIAL FWY
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF26552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134027502Medicaid
TXJ13QOtherBLUE CROSS BLUE SHIELD
TX84K951Medicare ID - Type UnspecifiedGROUP PRACTICE
TX134027502Medicaid