Healthcare Provider Details

I. General information

NPI: 1164422705
Provider Name (Legal Business Name): JANICE DEBRA VICTOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3536 N FEDERAL HWY STE 102
FORT LAUDERDALE FL
33308
US

IV. Provider business mailing address

PO BOX 11205
FORT LAUDERDALE FL
33339-1205
US

V. Phone/Fax

Practice location:
  • Phone: 888-620-7245
  • Fax: 888-371-1413
Mailing address:
  • Phone: 888-620-7246
  • Fax: 888-371-1413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME100973
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: