Provider Demographics
NPI:1770615783
Name:ORR, VICTOR LANE (ISC)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:LANE
Last Name:ORR
Suffix:
Gender:M
Credentials:ISC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-5151
Mailing Address - Country:US
Mailing Address - Phone:307-266-1597
Mailing Address - Fax:307-472-4751
Practice Address - Street 1:1226 E 24TH ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-5151
Practice Address - Country:US
Practice Address - Phone:307-266-1597
Practice Address - Fax:307-472-4751
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY171M00000X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator