Provider Demographics
NPI:1770689465
Name:VOLZ, VICKI A (MD)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:A
Last Name:VOLZ
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 1:910 N WASHINGTON ST
Mailing Address - Street 2:STE 209
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 W 8TH AVE
Practice Address - Street 2:STE 4200
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2307
Practice Address - Country:US
Practice Address - Phone:509-474-2730
Practice Address - Fax:509-462-4086
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020010208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003991700Medicaid
MT0146421Medicaid
WA0200979OtherL&I PROVIDER NUMBER
WA6033VOOtherASURIS PROVIDER NUMBER
IDKAT86OtherBC OF IDAHO PROVIDER NUMB
WA000010153735OtherREGENCE BS OF ID PROVIDER
WA8321804Medicaid
WAAB32999OtherMEDICARE GROUP
WA4021118OtherAETNA PROVIDER NUMBER
WAAB32999OtherMEDICARE GROUP
IDKAT86OtherBC OF IDAHO PROVIDER NUMB