Healthcare Provider Details

I. General information

NPI: 1093755027
Provider Name (Legal Business Name): DAVID VANBUREN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6145 N THESTA ST
FRESNO CA
93710-5266
US

IV. Provider business mailing address

6145 N THESTA ST
FRESNO CA
93710-5266
US

V. Phone/Fax

Practice location:
  • Phone: 559-446-1065
  • Fax: 559-436-8193
Mailing address:
  • Phone: 559-446-1065
  • Fax: 559-436-8193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberG5725
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberC54839
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG5725
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC54839
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberC54839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: