Healthcare Provider Details

I. General information

NPI: 1710240965
Provider Name (Legal Business Name): VICTOR ALEKSEYEVICH PUZEVICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MEDICAL DISTRICT DRIVE NEUROSURGEONS FOR CHILDREN
DALLAS TX
75235
US

IV. Provider business mailing address

8507 CAPRICORN WAY UNIT 89
SAN DIEGO CA
92126-1878
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-6660
  • Fax:
Mailing address:
  • Phone: 858-635-9445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number05944772
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: