Provider Demographics
NPI:1760412316
Name:DRAGON, VICTOR L (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:L
Last Name:DRAGON
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 1:1501 S PINELLAS AVE
Mailing Address - Street 2:SUITE T
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-1955
Mailing Address - Country:US
Mailing Address - Phone:727-934-6797
Mailing Address - Fax:
Practice Address - Street 1:1501 S PINELLAS AVE
Practice Address - Street 2:SUITE T
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-1955
Practice Address - Country:US
Practice Address - Phone:727-934-6796
Practice Address - Fax:727-942-6503
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39748208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067337400Medicaid
FL62378Medicare ID - Type Unspecified
FL067337400Medicaid