Basic Information
| Provider Information | |||||||||
| NPI: | 1659639888 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VANCE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | FRANK | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MEDICAL PARK BLVD | ||||||||
| Address2: | 250 WEST | ||||||||
| City: | BRISTOL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376208887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238446620 | ||||||||
| FaxNumber: | 4238446626 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MEDICAL PARK BLVD STE 250W | ||||||||
| Address2: | |||||||||
| City: | BRISTOL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238446620 | ||||||||
| FaxNumber: | 4238446626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2012 | ||||||||
| LastUpdateDate: | 09/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | DO0000003448 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.