Healthcare Provider Details

I. General information

NPI: 1659315174
Provider Name (Legal Business Name): VICTOR LEO RIZZO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST DEPARTMENT OF ANESTHESIOLOGY & PERIOPERATIVE MEDICINE,
AUGUSTA GA
30912-2700
US

IV. Provider business mailing address

75 SHELBURNE ST
BLUFFTON SC
29910-7819
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3873
  • Fax:
Mailing address:
  • Phone: 609-289-9755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number67975
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: