Provider Demographics
NPI:1285021006
Name:GONZALEZ BENITEZ, VICTOR DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:DAVID
Last Name:GONZALEZ BENITEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VICTOR
Other - Middle Name:DAVID
Other - Last Name:GONZALEZ BENITEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17TH & CHEW STREETS
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104
Practice Address - Country:US
Practice Address - Phone:610-969-3600
Practice Address - Fax:610-969-3601
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD455846207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine