Provider Demographics
NPI:1689669772
Name:VANEK, DAVID VANCE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:VANCE
Last Name:VANEK
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 1:9395 W POCATELLO CREEK RD
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-9049
Mailing Address - Country:US
Mailing Address - Phone:208-232-1162
Mailing Address - Fax:208-232-1162
Practice Address - Street 1:9395 W POCATELLO CREEK RD
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-9049
Practice Address - Country:US
Practice Address - Phone:208-232-1162
Practice Address - Fax:208-241-7575
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM4597208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010005817OtherREGENCE BLUE SHIELD OF ID
ID45971OtherBLUE CROSS OF IDAHO
IDD72142Medicare UPIN
ID000010005817OtherREGENCE BLUE SHIELD OF ID