Provider Demographics
NPI:1831116540
Name:EDWARD A. VANEK, D.O., INC.
Entity Type:Organization
Organization Name:EDWARD A. VANEK, D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:VANEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-385-1244
Mailing Address - Street 1:3140 APRON AVE
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-5103
Mailing Address - Country:US
Mailing Address - Phone:209-385-1244
Mailing Address - Fax:209-385-1247
Practice Address - Street 1:3140 APRON AVE
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-5103
Practice Address - Country:US
Practice Address - Phone:209-385-1244
Practice Address - Fax:209-385-1247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9591207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A9591OtherMEDICAL LICENSE
CA20A9591OtherMEDICAL LICENSE