Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | E3135 | TX |
Y | 207RI0011X | Interventional Cardiology | E3135 | TX |
NPI | 1073501409 |
---|---|
Provider Name | Dr. William Sterling Vance JR. |
First Address | Fort Worth, TX 76104-2800 |
Second Address | Fort Worth, TX 76104-2800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 16/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060009934 | RAIL ROAD MEDICARE (01) | TX |
1384935-02 | (05) | TX |
85K235 | BLUE CROSS (01) | TX |
C22913 | (02) | TX |