Provider Demographics
NPI:1689643330
Name:VANOS, DAVID NEIL III
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:NEIL
Last Name:VANOS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W 5TH AVE
Mailing Address - Street 2:SUITE 250E
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-4880
Mailing Address - Country:US
Mailing Address - Phone:509-838-8561
Mailing Address - Fax:509-835-4058
Practice Address - Street 1:104 W 5TH AVE
Practice Address - Street 2:SUITE 250E
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-4880
Practice Address - Country:US
Practice Address - Phone:509-838-8561
Practice Address - Fax:509-835-4058
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028669207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1079664Medicaid
WA1079664Medicaid
000345113Medicare PIN
WAG000345113Medicare ID - Type Unspecified