Provider Demographics
NPI:1154417707
Name:FYFE, STEVEN TREY (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:TREY
Last Name:FYFE
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 1:720 W 34TH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1205
Mailing Address - Country:US
Mailing Address - Phone:512-346-7600
Mailing Address - Fax:512-346-7603
Practice Address - Street 1:720 W 34TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1205
Practice Address - Country:US
Practice Address - Phone:512-346-7600
Practice Address - Fax:512-346-7603
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0993207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135676809Medicaid
TX135676810Medicaid
TX8AH420OtherBCBS PROVIDER ID NUMBER
TX8F5920Medicare PIN
TX135676809Medicaid