Provider Demographics
NPI:1770549982
Name:WEAVER, VICTORIA (MD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1215 N MCDONALD ROAD
Mailing Address - Street 2:#101
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216
Mailing Address - Country:US
Mailing Address - Phone:509-924-1950
Mailing Address - Fax:509-921-0017
Practice Address - Street 1:1512 N VERCLER RD
Practice Address - Street 2:#201
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1087
Practice Address - Country:US
Practice Address - Phone:509-921-6611
Practice Address - Fax:509-921-6613
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00033982207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1099191Medicaid
WA110253OtherL & I
WA1099191Medicaid
WA110253OtherL & I