Healthcare Provider Details

I. General information

NPI: 1932272291
Provider Name (Legal Business Name): VICTOR JOSEPH LUZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 RACE TRACK RD STE 101
JACKSONVILLE FL
32259
US

IV. Provider business mailing address

1631 RACE TRACK RD STE 101
JACKSONVILLE FL
32259-3233
US

V. Phone/Fax

Practice location:
  • Phone: 904-230-7977
  • Fax: 904-230-7979
Mailing address:
  • Phone: 904-230-7977
  • Fax: 904-230-7979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME83845
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: