Provider Demographics
NPI:1386662104
Name:VICTOR, DAVID W JR (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:VICTOR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:425 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1077
Mailing Address - Country:US
Mailing Address - Phone:606-784-1049
Mailing Address - Fax:606-783-1099
Practice Address - Street 1:425 CLINIC DR
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1077
Practice Address - Country:US
Practice Address - Phone:606-784-7551
Practice Address - Fax:606-780-2373
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY20079208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64200793Medicaid
KY0940102Medicare PIN
KYC64667Medicare UPIN