Provider Demographics
NPI:1154497543
Name:VANSCHENCK, DON ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:ROBERT
Last Name:VANSCHENCK
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 1:1334 39TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6718
Mailing Address - Country:US
Mailing Address - Phone:916-296-9604
Mailing Address - Fax:
Practice Address - Street 1:2 SCRIPPS DR STE 310
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6207
Practice Address - Country:US
Practice Address - Phone:916-924-8754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG399592080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G399590Medicaid
CAG39959OtherCA MEDICAL LICENSE
CAD33315Medicare UPIN