Provider Demographics
NPI:1841588878
Name:VICTORIA VEIN & SURGERY CLINIC PLLC
Entity Type:Organization
Organization Name:VICTORIA VEIN & SURGERY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-575-8346
Mailing Address - Street 1:PO BOX 4532
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-4532
Mailing Address - Country:US
Mailing Address - Phone:361-575-8346
Mailing Address - Fax:361-575-8351
Practice Address - Street 1:1701 E RED RIVER ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5621
Practice Address - Country:US
Practice Address - Phone:361-575-8346
Practice Address - Fax:361-575-8351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6646208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1275672347OtherNPI INDIVIDUAL
TXM6646OtherSTATE LICENSE