Provider Demographics
NPI:1164515540
Name:BARAHONA, VICTOR (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:BARAHONA
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:PO BOX 797
Mailing Address - Street 2:
Mailing Address - City:FABENS
Mailing Address - State:TX
Mailing Address - Zip Code:79838-0797
Mailing Address - Country:US
Mailing Address - Phone:915-764-4321
Mailing Address - Fax:
Practice Address - Street 1:201 W. MAIN
Practice Address - Street 2:SUITE B
Practice Address - City:FABENS
Practice Address - State:TX
Practice Address - Zip Code:79838
Practice Address - Country:US
Practice Address - Phone:915-764-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7394208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000F15B8Medicaid
TX00F15BMedicare ID - Type Unspecified
TXP000F15B8Medicaid