Healthcare Provider Details

I. General information

NPI: 1366866477
Provider Name (Legal Business Name): VICTORIA PROFESSIONAL MEDICAL CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 N VIRGINIA ST
PORT LAVACA TX
77979-3025
US

IV. Provider business mailing address

PO BOX 3689
SUGAR LAND TX
77487-3310
US

V. Phone/Fax

Practice location:
  • Phone: 361-552-6713
  • Fax:
Mailing address:
  • Phone: 800-962-3303
  • Fax: 405-682-1586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRETT ZIMMERMAN
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 205-240-1159