Basic Information
| Provider Information | |||||||||
| NPI: | 1700222148 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VACA | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 E 23RD ST STE 230 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571052122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053226900 | ||||||||
| FaxNumber: | 6053226901 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 E 23RD ST STE 230 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571052122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053226900 | ||||||||
| FaxNumber: | 6053226901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2013 | ||||||||
| LastUpdateDate: | 09/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 12727 | SD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.