Provider Demographics
NPI:1215990437
Name:PAZOS, VICTOR (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:PAZOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 W 20TH AVE
Mailing Address - Street 2:SUITE G166
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1897
Mailing Address - Country:US
Mailing Address - Phone:305-835-0551
Mailing Address - Fax:305-696-7704
Practice Address - Street 1:7100 W 20TH AVE
Practice Address - Street 2:SUITE G166
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-835-0551
Practice Address - Fax:305-696-7704
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81933207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015939000Medicaid
FLME81933OtherSTATE LICENSE NUMBER
FL47996OtherBLUE CROSS BLUE SHIELD #
FLE5855Medicare ID - Type UnspecifiedMEDICARE NUMBER
FLH43932Medicare UPIN
FLE5855ZMedicare PIN