Provider Demographics
NPI:1740719574
Name:VANNESS, WILLIAM CHARLES II
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHARLES
Last Name:VANNESS
Suffix:II
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 CREEDMOOR PLACE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011
Mailing Address - Country:US
Mailing Address - Phone:765-208-0653
Mailing Address - Fax:
Practice Address - Street 1:4014 CREEDMOOR PL
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-1605
Practice Address - Country:US
Practice Address - Phone:765-208-0653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024333A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine