MEDICARE: DR. VICTORIA M MOOTS DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0521959	KS
2	207Q00000X	Family Medicine Physician	05-21959	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639166986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTORIA M MOOTS DO

Provider Business Mailing Address
First Line	:	437 CEDAR ST
Second Line	:
City	:	KINGMAN
State	:	KS
Zip	:	67068-1324
Country	:	US
Telephone Number	:	620-532-3101
Fax Number	:	620-532-3427

Provider Business Practice Location Address
First Line	:	437 NORTH CEDAR ST
Second Line	:
City	:	KINGMAN
State	:	KS
Zip	:	67068-1324
Country	:	US
Telephone Number	:	620-532-3101
Fax Number	:	620-532-3427

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	06/04/2014

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