Provider Demographics
NPI:1679891766
Name:MATTHEW J FICENEC, MD, PA
Entity Type:Organization
Organization Name:MATTHEW J FICENEC, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:FICENEC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-985-9403
Mailing Address - Street 1:1224 3RD ST STE 8
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2354
Mailing Address - Country:US
Mailing Address - Phone:361-985-9403
Mailing Address - Fax:361-881-9566
Practice Address - Street 1:1224 3RD ST STE 8
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2354
Practice Address - Country:US
Practice Address - Phone:361-985-9403
Practice Address - Fax:361-881-9566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2886208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty