Provider Demographics
NPI:1467559658
Name:PACE, VICTOR M (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:M
Last Name:PACE
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 4046
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4046
Mailing Address - Country:US
Mailing Address - Phone:417-269-2240
Mailing Address - Fax:417-269-2245
Practice Address - Street 1:1429 W SUNSHINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-2346
Practice Address - Country:US
Practice Address - Phone:417-269-2240
Practice Address - Fax:417-269-2245
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO122230OtherBLUECROSS OF MO
MO204015515Medicaid
MOG86835Medicare UPIN
005011908Medicare PIN
956295152Medicare PIN
P00375522Medicare PIN
P00005069Medicare PIN