Provider Demographics
NPI:1992868178
Name:VICTORIA, DOLORES VILLAMOR (MD)
Entity Type:Individual
Prefix:DR
First Name:DOLORES
Middle Name:VILLAMOR
Last Name:VICTORIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 97
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-0097
Mailing Address - Country:US
Mailing Address - Phone:256-492-0131
Mailing Address - Fax:256-494-6000
Practice Address - Street 1:242 BROCKFORD ROAD
Practice Address - Street 2:
Practice Address - City:HEFLIN
Practice Address - State:AL
Practice Address - Zip Code:36264-1608
Practice Address - Country:US
Practice Address - Phone:256-492-0131
Practice Address - Fax:334-382-1231
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL108712Medicaid
AL102I081338Medicare PIN
D31106Medicare UPIN