Provider Demographics
NPI:1104849736
Name:VANYA, RICHARD FRANCIS (PA-C)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:FRANCIS
Last Name:VANYA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 SW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2604
Mailing Address - Country:US
Mailing Address - Phone:405-473-7914
Mailing Address - Fax:
Practice Address - Street 1:3300 NW EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4418
Practice Address - Country:US
Practice Address - Phone:405-949-3349
Practice Address - Fax:405-552-0450
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1413363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK248510115Medicare ID - Type Unspecified
OKQ40184Medicare UPIN