Provider Demographics
NPI:1477703031
Name:VANCE, WASEET Z (MD, PA)
Entity Type:Individual
Prefix:
First Name:WASEET
Middle Name:Z
Last Name:VANCE
Suffix:
Gender:M
Credentials:MD, PA
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Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7015 A C SKINNER PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6932
Mailing Address - Country:US
Mailing Address - Phone:904-363-2113
Mailing Address - Fax:904-363-2606
Practice Address - Street 1:1715 EAGLE HARBOR PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4324
Practice Address - Country:US
Practice Address - Phone:904-264-6201
Practice Address - Fax:904-264-6858
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2010-01542085R0001X
TXN60802085R0001X
FLME1205142085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013013700Medicaid
FL013013700Medicaid