Provider Demographics
NPI:1508048919
Name:VICTOR, DAVID W III (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:VICTOR
Suffix:III
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 1:6445 MAIN STREET
Mailing Address - Street 2:OPC 22
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:137-441-4345
Mailing Address - Fax:
Practice Address - Street 1:6445 MAIN STREET
Practice Address - Street 2:OPC 22
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:137-441-4345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA201516207R00000X
TXP7593207RG0100X, 207RI0008X, 207RT0003X
MDD0071978207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX330482601Medicaid
MD442244900Medicaid
TX330482602Medicaid
TXP01707725OtherRR MEDICARE
LA201516OtherLOUSIANA MEDICAL LISCENSE
MD223810ZAEMOtherMEDICARE
TX8DY375OtherBLUE CROSS BLUE SHIELD
TX330482603Medicaid
MDD0071978OtherMD MEDICAL LICENSE
TX8DY375OtherBLUE CROSS BLUE SHIELD
TX330482602Medicaid
TX316323YKWUMedicare PIN