Healthcare Provider Details

I. General information

NPI: 1255369286
Provider Name (Legal Business Name): VANCE STOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E JEFFERSON ST
SILOAM SPRINGS AR
72761-3629
US

IV. Provider business mailing address

205 E JEFFERSON ST
SILOAM SPRINGS AR
72761-3629
US

V. Phone/Fax

Practice location:
  • Phone: 479-524-4141
  • Fax: 479-549-2576
Mailing address:
  • Phone: 479-524-4141
  • Fax: 479-549-2576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberE0324
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: