MEDICARE: VICTORIA TOVAR PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	363A00000X	Physician Assistant	PA17776	TX

General Provider Information

NPI Number	:	1265069553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA TOVAR PA

Provider Business Mailing Address
First Line	:	800 MEDICAL CENTER DR STE C
Second Line	:
City	:	DECATUR
State	:	TX
Zip	:	76234-3844
Country	:	US
Telephone Number	:	940-626-2110
Fax Number	:	940-626-2113

Provider Business Practice Location Address
First Line	:	1101 6TH AVE STE 110
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4929
Country	:	US
Telephone Number	:	817-912-8040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2020
Last Update Date	:	02/27/2025

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Directions to “ VICTORIA TOVAR PA” Practice Location

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