Provider Demographics
NPI:1922072834
Name:DREICER, VICTOR S (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:S
Last Name:DREICER
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 6599
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-1654
Mailing Address - Country:US
Mailing Address - Phone:334-699-7900
Mailing Address - Fax:334-944-7040
Practice Address - Street 1:4300 W MAIN ST STE 21
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1058
Practice Address - Country:US
Practice Address - Phone:334-699-7900
Practice Address - Fax:334-944-7040
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22952208G00000X
AL36316208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068002298OtherMEDICARE PTAN
AZ17887Medicaid
KS201109650AMedicaid
KS068002298OtherMEDICARE PTAN