Provider Demographics
NPI:1487759221
Name:LI-PELAEZ, VICTOR JUSTO (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:JUSTO
Last Name:LI-PELAEZ
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:711 W 38TH STREET
Mailing Address - Street 2:SUITE E3
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1132
Mailing Address - Country:US
Mailing Address - Phone:512-454-0423
Mailing Address - Fax:512-454-6436
Practice Address - Street 1:711 W 38TH STREET
Practice Address - Street 2:SUITE E3
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1132
Practice Address - Country:US
Practice Address - Phone:512-454-0423
Practice Address - Fax:512-454-6436
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD8019208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
2224370OtherBLUE LINK
TX0994089-01Medicaid
3235465OtherMET LINK
TX0994089-01Medicaid
B24370Medicare UPIN