Provider Demographics
NPI:1114961737
Name:HOWARD, VICTOR NICK (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:NICK
Last Name:HOWARD
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 1:4161 TAMIAMI TRL
Mailing Address - Street 2:SUITE 802
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9204
Mailing Address - Country:US
Mailing Address - Phone:941-625-6223
Mailing Address - Fax:941-627-2680
Practice Address - Street 1:4161 TAMIAMI TRL
Practice Address - Street 2:SUITE 802
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9204
Practice Address - Country:US
Practice Address - Phone:941-625-6223
Practice Address - Fax:941-627-2680
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53389174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME53389OtherMEDICAL LICENSE
FL07843WMedicare ID - Type Unspecified
FLME53389OtherMEDICAL LICENSE