Provider Demographics
NPI:1194718890
Name:TOFAEONO, VICTOR T (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:T
Last Name:TOFAEONO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VICTOR
Other - Middle Name:T
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX LBJ GENERAL DELIVERYGO
Mailing Address - Street 2:LBJ TROPICAL MEDICAL CENTER
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799
Mailing Address - Country:US
Mailing Address - Phone:684-633-1683
Mailing Address - Fax:684-633-1976
Practice Address - Street 1:123 TURNER DRIVE
Practice Address - Street 2:LBJ TROPICAL MEDICAL CENTER
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799
Practice Address - Country:US
Practice Address - Phone:684-633-1683
Practice Address - Fax:684-633-1976
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3725208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ASH82442Medicare UPIN