Provider Demographics
NPI:1164422705
Name:VICTOR, JANICE DEBRA (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:DEBRA
Last Name:VICTOR
Suffix:
Gender:F
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:PO BOX 11205
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33339-1205
Mailing Address - Country:US
Mailing Address - Phone:888-620-7246
Mailing Address - Fax:888-371-1413
Practice Address - Street 1:3536 N FEDERAL HWY STE 102
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:888-620-7245
Practice Address - Fax:888-371-1413
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100973207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83721CMedicare PIN
VI85468AMedicare PIN