Provider Demographics
NPI:1639132566
Name:MCNAMARA, VICTOR FRANCIS (DPM)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:FRANCIS
Last Name:MCNAMARA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 OUTER RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6652
Mailing Address - Country:US
Mailing Address - Phone:407-228-2838
Mailing Address - Fax:407-894-5151
Practice Address - Street 1:899 OUTER RD
Practice Address - Street 2:SUITE C
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6652
Practice Address - Country:US
Practice Address - Phone:407-228-2838
Practice Address - Fax:407-894-5151
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-1882213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390000200Medicaid
FL65032Medicare ID - Type UnspecifiedMEDICARE NUMBER
FL390000200Medicaid
FL1175660001Medicare NSC