Provider Demographics
NPI:1093755027
Name:VANBUREN, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:VANBUREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6145 N THESTA ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5266
Mailing Address - Country:US
Mailing Address - Phone:559-446-1065
Mailing Address - Fax:559-436-8193
Practice Address - Street 1:6145 N THESTA ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5266
Practice Address - Country:US
Practice Address - Phone:559-446-1065
Practice Address - Fax:559-436-8193
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5725204F00000X, 208600000X
CAC54839204F00000X, 208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G0350OtherBC/BS
TX151818501Medicaid
OK100043740AMedicaid
TX151818503Medicaid
TX020052581OtherMEDICARE RAILROAD
TX130529101OtherFIRSTCARE COMMERCIAL
NM201038181OtherPRESBYTERIAN COMMERCIAL
NM62476254Medicaid
TX130529102Medicaid
NMA539OtherTRIWEST
TX450686CA99685OtherSECTION 1011
NM201038181Medicaid
TX86665ZOtherHMO BLUE
NMA539OtherTRIWEST
NM62476254Medicaid