Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | E9140 | AR |
NPI | 1205001799 |
---|---|
Provider Name | David Vance |
First Address | Jonesboro, AR 72401-4163 |
Second Address | Jonesboro, AR 72401-4163 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2008 |
Last Update Date | 16/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
211789001 | (05) | AR |