Healthcare Provider Details

I. General information

NPI: 1104213412
Provider Name (Legal Business Name): BRYCE ALSTON VANCE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 GENE GEORGE BLVD
SPRINGDALE AR
72762-0845
US

IV. Provider business mailing address

2601 GENE GEORGE BLVD
SPRINGDALE AR
72762-0845
US

V. Phone/Fax

Practice location:
  • Phone: 479-309-5391
  • Fax: 479-725-6582
Mailing address:
  • Phone: 479-309-5391
  • Fax: 479-725-6582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0059282
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberE-19652
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-19652
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberDR.0059282
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: