Provider Demographics
NPI:1841290095
Name:ATUN, VICTOR J (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:J
Last Name:ATUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:15591 CREEK BEND DR
Mailing Address - Street 2:STE 100
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4628
Mailing Address - Country:US
Mailing Address - Phone:281-232-6700
Mailing Address - Fax:281-232-4545
Practice Address - Street 1:17510 W.GRAND PARKWAY S.
Practice Address - Street 2:SUITE 500
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4513
Practice Address - Country:US
Practice Address - Phone:281-232-6700
Practice Address - Fax:281-232-4545
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2018-11-17
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
TXK6986208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029834101Medicaid
029834101OtherTEXAS CHILDRENS HEALTH PLAN
TX2431256OtherAETNA US HEALTHCARE
TX029834101OtherAMERIGROUP
TX8F4931OtherBCBS OF TEXAS
TX029834101Medicaid
029834101OtherTEXAS CHILDRENS HEALTH PLAN