Provider Demographics
NPI:1942203898
Name:BOODHOO, VICTOR R (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:R
Last Name:BOODHOO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:805 CENTURY MEDICAL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2100
Mailing Address - Country:US
Mailing Address - Phone:321-268-6264
Mailing Address - Fax:321-267-2713
Practice Address - Street 1:250 HARRISON STREET
Practice Address - Street 2:PARRISH MEDICAL GROUP
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780
Practice Address - Country:US
Practice Address - Phone:321-268-6868
Practice Address - Fax:321-267-2713
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-04-20
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Provider Licenses
StateLicense IDTaxonomies
FLME 30988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037130100Medicaid
FL037130100Medicaid