Provider Demographics
NPI:1659319481
Name:VINZANT, MARK N (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:N
Last Name:VINZANT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1410 N WOODLAWN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-2922
Mailing Address - Country:US
Mailing Address - Phone:316-788-3741
Mailing Address - Fax:316-788-5198
Practice Address - Street 1:1410 N WOODLAWN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-2922
Practice Address - Country:US
Practice Address - Phone:316-788-3741
Practice Address - Fax:316-788-5198
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2008-06-23
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Provider Licenses
StateLicense IDTaxonomies
KS0417161207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS006432OtherBC/BS
KS006432OtherBC/BS
KSB91248Medicare UPIN
KS006432Medicare PIN