Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | G8483 | TX |
N | 207V00000X | Obstetrician & Gynecologist | G8483 | TX |
NPI | 1568468395 |
---|---|
Provider Name | Dr. Victor L Vines |
First Address | Denton, TX 76205-7878 |
Second Address | Denton, TX 76205-7878 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 17/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
115235704 | (05) | TX |
115235705 | (05) | TX |
8437B0 | BCBS (01) | TX |
8BD727 | BCBS (01) | TX |