Provider Demographics
NPI:1710909635
Name:VOGLE, VICTORIA (DO)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:VOGLE
Suffix:
Gender:F
Credentials:DO
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 249
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-7154
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1615 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2367
Practice Address - Country:US
Practice Address - Phone:360-414-2000
Practice Address - Fax:360-414-7555
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7849207L00000X
WY6955A207L00000X
WA00001911207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0228015OtherWA LABOR AND IND.
OR270156Medicaid
WA8487878Medicaid
WY119933100Medicaid
WA8946817OtherWA CRIME VICTIMS
WY10197Medicare ID - Type Unspecified
OR270156Medicaid
WA0008869935Medicare NSC