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General NPI Number Information
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NPI Number | 1124114467
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Entity Type | Organization
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Legal Business Name | VICTORIA ELECTROCARDIOGRAPHY
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 1908 N LAURENT ST SUITE 550
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City | VICTORIA
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State | TX
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Zip | 77901-5468
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Country | US
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Telephone | 361-572-0333
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Fax | 361-572-0104
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Provider Business Mailing Address
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Address Line | 1908 N LAURENT ST SUITE 550
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City | VICTORIA
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State | TX
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Zip | 77901-5468
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Country | US
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Telephone | 361-572-0333
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Fax | 361-572-0104
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Authorized Official
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Title or Position | DIRECTOR
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Name | JAMES GRUMMAN
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Credential | MD
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Telephone | 361-572-0333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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