Provider Demographics
NPI:1407803026
Name:STOCKER, VICTORIA K (MD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:K
Last Name:STOCKER
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 1:11120 NE 33RD PL STE 202
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1444
Mailing Address - Country:US
Mailing Address - Phone:206-823-1004
Mailing Address - Fax:
Practice Address - Street 1:11120 NE 33RD PL STE 202
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1444
Practice Address - Country:US
Practice Address - Phone:206-823-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8230815Medicaid
WA0160487OtherLABOR AND INDUSTRY
WAMD00036621OtherSTATE LICENSE NUMBER
WAP00161558OtherRAILROAD MEDICARE
WA8230815Medicaid
WAAB27497Medicare PIN