Provider Demographics
NPI:1275893901
Name:PIPER, VICTOR GLADSTONE
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:GLADSTONE
Last Name:PIPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7781 BILTMORE BLVD
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5825
Mailing Address - Country:US
Mailing Address - Phone:954-964-7448
Mailing Address - Fax:954-963-9038
Practice Address - Street 1:7781 BILTMORE BLVD
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-5825
Practice Address - Country:US
Practice Address - Phone:954-964-7448
Practice Address - Fax:954-963-9038
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVCJTVH7PMedicare PIN