MEDICARE: DR. VICTOR L VINES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	G8483	TX
2	207QA0401X	Addiction Medicine (Family Medicine) Physician	G8483	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8BD727	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8437B0	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1568468395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTOR L VINES MD

Provider Business Mailing Address
First Line	:	700 LONDONDERRY LN
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76205-7878
Country	:	US
Telephone Number	:	940-387-3871
Fax Number	:	940-243-8001

Provider Business Practice Location Address
First Line	:	700 LONDONDERRY LN
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76205-7878
Country	:	US
Telephone Number	:	940-387-3871
Fax Number	:	940-243-8001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	09/17/2019

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