Provider Demographics
NPI:1528059300
Name:VICTOR, ROBERT MICHAEL (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:VICTOR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 RIO LINDO AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1800
Mailing Address - Country:US
Mailing Address - Phone:530-894-6195
Mailing Address - Fax:530-894-6195
Practice Address - Street 1:578 RIO LINDO AVE STE 4
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1800
Practice Address - Country:US
Practice Address - Phone:530-894-6195
Practice Address - Fax:530-894-6195
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4578213E00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00467744OtherRR MEDICARE PIN
ORV00284Medicare UPIN
OR133261Medicare PIN
OR286712OtherMEDICAID GROUP
ORCH0625OtherRR MEDICARE GROUP
OR133261Medicare PIN
OR273863Medicaid