Provider Demographics
NPI:1932272291
Name:LUZ, VICTOR JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:JOSEPH
Last Name:LUZ
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 1:1631 RACE TRACK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3233
Mailing Address - Country:US
Mailing Address - Phone:904-230-7977
Mailing Address - Fax:904-230-7979
Practice Address - Street 1:1631 RACE TRACK RD STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259
Practice Address - Country:US
Practice Address - Phone:904-230-7977
Practice Address - Fax:904-230-7979
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83845208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263973400Medicaid
G00841Medicare UPIN