Provider Demographics
NPI:1700848223
Name:MOHR, VICTORIA H (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:H
Last Name:MOHR
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:PO BOX 1749
Mailing Address - Street 2:C/O CREDENTIALING-DEB NOVAK
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-1749
Mailing Address - Country:US
Mailing Address - Phone:970-926-6335
Mailing Address - Fax:970-926-6348
Practice Address - Street 1:322 BEARD CREEK ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632
Practice Address - Country:US
Practice Address - Phone:970-926-6340
Practice Address - Fax:970-926-6348
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46103207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270136700Medicaid
CO810457OtherMEDICARE ID-UNSPECIFIED
CO96831553Medicaid
CO96831553Medicaid
FLI12611Medicare UPIN
FL43269ZMedicare ID - Type UnspecifiedMEDICARE