Provider Demographics
NPI:1538160080
Name:BAGA, VICTOR B (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:B
Last Name:BAGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:517 RIVIERA ST
Mailing Address - Street 2:UNIT C
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2827
Mailing Address - Country:US
Mailing Address - Phone:941-485-2647
Mailing Address - Fax:941-870-9236
Practice Address - Street 1:517 RIVIERA ST
Practice Address - Street 2:UNIT C
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2827
Practice Address - Country:US
Practice Address - Phone:941-485-2647
Practice Address - Fax:941-870-9236
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME22039207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049765700Medicaid
FL78244OtherBCBS
FL26-3408507OtherITIN
FL049765700Medicaid
FL26-3408507OtherITIN