Healthcare Provider Details

I. General information

NPI: 1851385660
Provider Name (Legal Business Name): JAMES R VANCUREN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 PROFESSIONAL DR
GOSHEN IN
46526-3819
US

IV. Provider business mailing address

1262 CAMDEN CT
GOSHEN IN
46526-6450
US

V. Phone/Fax

Practice location:
  • Phone: 574-533-0348
  • Fax: 574-533-0277
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01022379
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: