MEDICARE: DR. VICTOR R BOODHOO 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	207Q00000X	Family Medicine Physician	ME 30988	FL

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

General Provider Information

NPI Number	:	1942203898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTOR R BOODHOO MD

Provider Business Mailing Address
First Line	:	805 CENTURY MEDICAL DR
Second Line	:	SUITE C
City	:	TITUSVILLE
State	:	FL
Zip	:	32796-2100
Country	:	US
Telephone Number	:	321-268-6264
Fax Number	:	321-267-2713

Provider Business Practice Location Address
First Line	:	250 HARRISON STREET
Second Line	:	PARRISH MEDICAL GROUP
City	:	TITUSVILLE
State	:	FL
Zip	:	32780
Country	:	US
Telephone Number	:	321-268-6868
Fax Number	:	321-267-2713

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	04/20/2021

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