Provider Demographics
NPI:1114054095
Name:MOFFATT, VICTORIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:L
Last Name:MOFFATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 E 13TH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-5161
Mailing Address - Country:US
Mailing Address - Phone:970-820-4264
Mailing Address - Fax:970-820-4278
Practice Address - Street 1:2555 E 13TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-5161
Practice Address - Country:US
Practice Address - Phone:970-820-4264
Practice Address - Fax:970-820-4278
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-45776207R00000X
WI298-320207R00000X
AZ57666207R00000X
MN64790207R00000X
WAMD60915947207R00000X
IL036147734207R00000X
NV18451207R00000X
SD11238207R00000X
UT11066591-1205207R00000X
TXS0746207R00000X
ND15971207R00000X
MDD88182207R00000X
CO37607207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO36878391Medicaid
CO010933OtherKAISER COMMERCIAL NUMBER
CO010933OtherKAISER COMMERCIAL NUMBER
COCOA105523Medicare PIN
COCK10855Medicare PIN