Provider Demographics
NPI:1477596344
Name:VANCE, ESTIL AUGUST (MD)
Entity Type:Individual
Prefix:DR
First Name:ESTIL
Middle Name:AUGUST
Last Name:VANCE
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:7777 FOREST LN STE D220
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2571
Practice Address - Country:US
Practice Address - Phone:972-566-7790
Practice Address - Fax:972-566-3034
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6385207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124287701Medicaid
TX124287704Medicaid
TX124287702OtherCSHCN
NM24488712Medicaid
OK100138960AMedicaid
TX124287703Medicaid
TX124287705Medicaid
TX8R1574OtherBLUE CROSS OF TEXAS
TX88231KMedicare PIN
TX8R1574OtherBLUE CROSS OF TEXAS
TX88231KMedicare ID - Type Unspecified
TX124287704Medicaid
TX80791KMedicare PIN
TX124287703Medicaid