Provider Demographics
NPI:1023454386
Name:MAKKOUK, FUAD (MD)
Entity type:Individual
Prefix:
First Name:FUAD
Middle Name:
Last Name:MAKKOUK
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 1:9707 ANDERSON MILL RD STE 230
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-2300
Mailing Address - Country:US
Mailing Address - Phone:512-693-9363
Mailing Address - Fax:
Practice Address - Street 1:9707 ANDERSON MILL RD STE 230
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2300
Practice Address - Country:US
Practice Address - Phone:512-693-9363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1.056429207W00000X
TXS0733207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology