Provider Demographics
NPI:1194971077
Name:BETTERLIFE BARIATRICS OF VICTORIA LLC
Entity type:Organization
Organization Name:BETTERLIFE BARIATRICS OF VICTORIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:361-574-1888
Mailing Address - Street 1:2705 HOSPITAL DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5775
Mailing Address - Country:US
Mailing Address - Phone:361-574-1888
Mailing Address - Fax:361-574-1558
Practice Address - Street 1:2705 HOSPITAL DR
Practice Address - Street 2:SUITE 400
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5775
Practice Address - Country:US
Practice Address - Phone:361-574-1888
Practice Address - Fax:361-574-1558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0999208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty