Healthcare Provider Details

I. General information

NPI: 1275566309
Provider Name (Legal Business Name): VICTOR ALBERTO PACHECO-FOWLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: VICTOR ALBERTO PACHECO

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/28/2022
Certification Date: 09/27/2022
Deactivation Date: 07/19/2006
Reactivation Date: 10/24/2006

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
APO AE
09180-3100
US

IV. Provider business mailing address

LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
APO AE
09180-3100
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-6322
  • Fax:
Mailing address:
  • Phone: 314-590-6322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberM1977
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: