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General NPI Number Information
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NPI Number | 1982167367
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Entity Type | Individual
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Provider Name | VICTOR SHOWALTER
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Gender | Male
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Dates
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Enumeration Date | 04/11/2019
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Last Update Date | 06/02/2024
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Provider Practice Location Address
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Address Line | 509 N ELAM AVE
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City | GREENSBORO
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State | NC
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Zip | 27403-1129
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Country | US
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Telephone | 336-274-1114
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Fax |
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Provider Business Mailing Address
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Address Line | 509 N ELAM AVE
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City | GREENSBORO
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State | NC
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Zip | 27403-1129
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Country | US
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Telephone | 336-274-1114
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 2024-01027
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License Number State | NC
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