Healthcare Provider Details

I. General information

NPI: 1730407784
Provider Name (Legal Business Name): CHRISTOPHER CHARLES VANISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BANNER MD ANDERSON CANCER CENTER 2946 E BANNER GATEWAY DRIVE
GILBERT AZ
85234
US

IV. Provider business mailing address

101 NICOLLS RD
STONY BROOK NY
11794-0001
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-6444
  • Fax: 480-256-3682
Mailing address:
  • Phone: 631-444-7661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number54821
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: