Provider Demographics
NPI:1699715094
Name:HORSLEY, VICTOR L (DPM)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:L
Last Name:HORSLEY
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 1:4901 WEST MAIN
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226
Mailing Address - Country:US
Mailing Address - Phone:618-222-1986
Mailing Address - Fax:618-222-1898
Practice Address - Street 1:4901 WEST MAIN
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226
Practice Address - Country:US
Practice Address - Phone:618-222-1986
Practice Address - Fax:618-222-1898
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004072213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL128062OtherHEALTHLINK
IL127962OtherUNITED HEALTHCARE
IL08232169OtherBCBS
IL016004072Medicaid
IL08232169OtherBCBS
IL212366Medicare ID - Type Unspecified