Provider Demographics
NPI:1497820070
Name:GENCHI, VICTOR JOSEPH (MD)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:JOSEPH
Last Name:GENCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VICTOR
Other - Middle Name:J
Other - Last Name:GENCHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2619 PALM DEER DR
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-2563
Mailing Address - Country:US
Mailing Address - Phone:561-246-2111
Mailing Address - Fax:561-798-1956
Practice Address - Street 1:2619 PALM DEER DR
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-2563
Practice Address - Country:US
Practice Address - Phone:561-246-2111
Practice Address - Fax:561-798-1956
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57874207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052184100Medicaid
650885224OtherTAX IDENTIFIER EIN
650288997OtherTAX IDENTIFIER EIN
FLE91788Medicare UPIN
650885224OtherTAX IDENTIFIER EIN
FL052184100Medicaid
FL11839CMedicare PIN