Provider Demographics
NPI:1366542268
Name:MANDOFF, VICTOR L (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:L
Last Name:MANDOFF
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 1:4301 W MARKHAM ST
Mailing Address - Street 2:UAMS SLOT 515
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-7918
Mailing Address - Fax:501-686-8139
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:UAMS SLOT 515
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-7918
Practice Address - Fax:501-686-8139
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4786207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR06070017500OtherQUALCHOICE
ARP00350684OtherRAILROAD MEDICARE
ARE4786OtherTRICARE
AR5N541OtherBCBS
AR5N5416884Medicare ID - Type Unspecified
ARP00350684OtherRAILROAD MEDICARE