Provider Demographics
NPI:1083665269
Name:KOO, VICTOR S (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:S
Last Name:KOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4415 WOODFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-5303
Mailing Address - Country:US
Mailing Address - Phone:561-736-3888
Mailing Address - Fax:561-732-1737
Practice Address - Street 1:2623 S SEACREST BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7501
Practice Address - Country:US
Practice Address - Phone:561-736-3888
Practice Address - Fax:561-732-1737
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME37667207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065231100Medicaid
FLD65239Medicare UPIN
FL61128Medicare ID - Type Unspecified