Provider Demographics
NPI:1881636991
Name:HORADAM, VICTOR WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:WILLIAM
Last Name:HORADAM
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:4700 N GALLOWAY AVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-1516
Practice Address - Country:US
Practice Address - Phone:972-686-6411
Practice Address - Fax:972-686-0594
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6425207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135707103Medicaid
TX135707102Medicaid
TX135707109Medicaid
TX135707105Medicaid
TX135707104Medicaid
TX135707101Medicaid
TX8R1467OtherBLUE CROSS OF TEXAS
TX135707111Medicaid
TX135707105Medicaid
TX135707101Medicaid
TX900003054Medicare PIN
TX892848Medicare PIN
TX88260KMedicare PIN
TXB23581Medicare UPIN