Provider Demographics
NPI:1407818743
Name:VANCE, RAYMOND M (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:M
Last Name:VANCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3737 MORAGA AVE
Mailing Address - Street 2:SUITE A106
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5404
Mailing Address - Country:US
Mailing Address - Phone:858-270-4420
Mailing Address - Fax:858-270-8199
Practice Address - Street 1:3737 MORAGA AVE
Practice Address - Street 2:SUITE A106
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5404
Practice Address - Country:US
Practice Address - Phone:858-270-4420
Practice Address - Fax:858-270-8199
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG30115207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG30115OtherSTATE LICENSE
CAWG30115AMedicare ID - Type Unspecified
CAG30115OtherSTATE LICENSE