Provider Demographics
NPI:1326261637
Name:VANCE, DAVID D (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:VANCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:948 STEVENS DR STE A
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3547
Mailing Address - Country:US
Mailing Address - Phone:509-946-5150
Mailing Address - Fax:509-946-6547
Practice Address - Street 1:948 STEVENS DR STE A
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3547
Practice Address - Country:US
Practice Address - Phone:509-946-5150
Practice Address - Fax:509-946-6547
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2021-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60192684208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1004376Medicaid