Healthcare Provider Details

I. General information

NPI: 1700911690
Provider Name (Legal Business Name): RAYMOND A. VANVUREN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 S BLOOMINGTON ST
GREENCASTLE IN
46135-2212
US

IV. Provider business mailing address

105 DEMING LN
TERRE HAUTE IN
47803-2080
US

V. Phone/Fax

Practice location:
  • Phone: 513-231-0922
  • Fax: 513-231-6906
Mailing address:
  • Phone: 812-877-1536
  • Fax: 513-231-6906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01035915
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: