Basic Information
| Provider Information | |||||||||
| NPI: | 1053391623 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SETSER | ||||||||
| FirstName: | VICTOR | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2395 | ||||||||
| Address2: | |||||||||
| City: | HARRISON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726022395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707439215 | ||||||||
| FaxNumber: | 8707439215 | ||||||||
| Practice Location | |||||||||
| Address1: | HWY 14 EAST | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN VIEW | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702694361 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | C00198 CRNA | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 59824 | 01 | AR | BLUE SHIELD | OTHER |