Provider Demographics
NPI:1073554317
Name:VALCOUR, VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:VALCOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 ALA MOANA BLVD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5471
Mailing Address - Country:US
Mailing Address - Phone:808-535-5975
Mailing Address - Fax:808-535-5976
Practice Address - Street 1:3675 KILAUEA AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-2333
Practice Address - Country:US
Practice Address - Phone:808-737-2751
Practice Address - Fax:808-735-7047
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD9863174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIPENDINGMedicaid
HIPENDINGMedicare ID - Type Unspecified
HIG60747Medicare UPIN