Healthcare Provider Details

I. General information

NPI: 1043266075
Provider Name (Legal Business Name): VICTORIA A GENSEMER D.P.M., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 LINTON BLVD SUITE 305
DELRAY BEACH FL
33484-6542
US

IV. Provider business mailing address

5210 LINTON BLVD SUITE 305
DELRAY BEACH FL
33484-6542
US

V. Phone/Fax

Practice location:
  • Phone: 561-498-9888
  • Fax: 561-498-7626
Mailing address:
  • Phone: 561-498-9888
  • Fax: 561-498-7626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3138
License Number StateFL

VIII. Authorized Official

Name: DR. VICTORIA A GENSEMER
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 561-498-9888