Provider Demographics
NPI:1568494045
Name:KOLOKOFF, VALERIE (MD)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:KOLOKOFF
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 1:5616 S RAVENCREST DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-5329
Mailing Address - Country:US
Mailing Address - Phone:509-828-9348
Mailing Address - Fax:
Practice Address - Street 1:GONZAGA UNIVERSITY STUDENT HEALTH 704 E SHARP
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99258
Practice Address - Country:US
Practice Address - Phone:509-313-4066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00021494207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1080738Medicaid
WA103385OtherL&I
WA103385OtherL&I
WA000316137Medicare ID - Type Unspecified
WAA07620Medicare UPIN