Provider Demographics
NPI:1558374926
Name:KING, VICTORIA VAN BEUREN (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:VAN BEUREN
Last Name:KING
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 1:1210 APPLE LN
Mailing Address - Street 2:
Mailing Address - City:PENROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81240-9551
Mailing Address - Country:US
Mailing Address - Phone:719-429-0028
Mailing Address - Fax:
Practice Address - Street 1:113 LATIGO LN
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-8114
Practice Address - Country:US
Practice Address - Phone:719-371-0000
Practice Address - Fax:719-372-0505
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32334207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01323344Medicaid
CO01323344Medicaid