Healthcare Provider Details

I. General information

NPI: 1508048919
Provider Name (Legal Business Name): DAVID W VICTOR III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6445 MAIN STREET OPC 22
HOUSTON TX
77030
US

IV. Provider business mailing address

6445 MAIN STREET OPC 22
HOUSTON TX
77030
US

V. Phone/Fax

Practice location:
  • Phone: 137-441-4345
  • Fax:
Mailing address:
  • Phone: 137-441-4345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number201516
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberP7593
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD0071978
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberP7593
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License NumberP7593
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: