Provider Demographics
NPI:1245232792
Name:ANAZIA, VICTOR (DO)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:ANAZIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-4159
Mailing Address - Country:US
Mailing Address - Phone:601-249-0013
Mailing Address - Fax:601-249-0592
Practice Address - Street 1:120 5TH AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-4159
Practice Address - Country:US
Practice Address - Phone:601-249-0013
Practice Address - Fax:601-249-0592
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14997207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1174627459OtherNPI
MS00121885Medicaid
MS1245348499OtherNPI
MS1174627459OtherNPI
MS1245348499OtherNPI