Individual
FARZAN VICTORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 DR MARTIN LUTHER KING JR AVE NE, ALBUQUERQUE, NM 87102-3619
(505) 298-0301
Mailing address
PO BOX 4934, ALBUQUERQUE, NM 87196-4934
(505) 298-0301
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0101249264
VA
2085R0202X
Diagnostic Radiology Physician
Primary
MD2012-0597
NM
208D00000X
General Practice Physician
2006-0380
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
70379807
—
NM
01
—
NMA102940
MEDICARE PTAN
NM
Enumeration date
02/06/2007
Last updated
07/19/2016
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