Provider Demographics
NPI:1063418333
Name:FIKS, VLADIMIR B (MD)
Entity type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:B
Last Name:FIKS
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 1:10305 SW PARK WAY
Mailing Address - Street 2:STE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5033
Mailing Address - Country:US
Mailing Address - Phone:503-295-0730
Mailing Address - Fax:503-295-0731
Practice Address - Street 1:10305 SW PARK WAY
Practice Address - Street 2:STE 300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5033
Practice Address - Country:US
Practice Address - Phone:503-295-0730
Practice Address - Fax:503-295-0731
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2010-06-24
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
ORMD19358208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR080783Medicaid
OR080783Medicaid
ORR107977Medicare PIN