Healthcare Provider Details

I. General information

NPI: 1144282351
Provider Name (Legal Business Name): VICTOR J. TEST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TEXAS TECH PHYSICIANS 3601 4TH STREET STOP 9410
LUBBOCK TX
79430-9410
US

IV. Provider business mailing address

3601 4TH STREET STOP 9410 3601 4TH STREET STOP 9410
LUBBOCK TX
79430-9410
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-3150
  • Fax: 806-743-2893
Mailing address:
  • Phone: 806-743-3150
  • Fax: 806-743-2893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number28079
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2016-00065
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: