Provider Demographics
NPI:1255449047
Name:SERALDE, VICTOR MEDINA (MD)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:MEDINA
Last Name:SERALDE
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 1:3750 US HIGHWAY 27 N STE 4F
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-1658
Mailing Address - Country:US
Mailing Address - Phone:863-382-4949
Mailing Address - Fax:863-382-3811
Practice Address - Street 1:3750 US HIGHWAY 27 N STE 4F
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1658
Practice Address - Country:US
Practice Address - Phone:863-382-4949
Practice Address - Fax:863-382-3811
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0041355208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41214COtherMEDICARE PROVIDER NUMBER CIRILO SERALDE IN FAIRMOUNT CLINIC
FL259715200OtherMEDIPASS PROVIDER NUMBER GROUP
FL28115AOtherMEDICARE PROVIDER NUMBER OF VICTOR SERALDE IN FAIRMOUNT CLINIC
FLK2401OtherMEDICARE PART B GROUP PROVIDER NUMBER
FL28115OtherMEDICARE INDIVIDUAL PROVIDER DR. VICTOR SERALDE
FL067369200OtherMEDICAID INDIVIDUAL PROVIDER VICTOR SERALDE
FL259715200OtherMEDIPASS PROVIDER NUMBER GROUP
FL41214COtherMEDICARE PROVIDER NUMBER CIRILO SERALDE IN FAIRMOUNT CLINIC
FLK2401OtherMEDICARE PART B GROUP PROVIDER NUMBER