MEDICARE: VICTOR A VALLEJO MD

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	207R00000X	Internal Medicine Physician	38642	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01016892	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	4308730	OTHER	TN	BCBST
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	6011152	OTHER	TN	BLUE CROSS-BLUE SHIELD

General Provider Information

NPI Number	:	1679539886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR A VALLEJO MD

Provider Business Mailing Address
First Line	:	2300 PATTERSON ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1538
Country	:	US
Telephone Number	:	615-342-6828
Fax Number	:	615-342-6836

Provider Business Practice Location Address
First Line	:	2300 PATTERSON ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1538
Country	:	US
Telephone Number	:	615-342-6828
Fax Number	:	615-342-6836

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	03/31/2017

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Directions to “ VICTOR A VALLEJO MD” Practice Location

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