Physician Compare National (NPI:1336219930)

HEALTHCARE PROVIDER: DONALD DUANE VANFOSSAN M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1336219930
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0941201644
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080416000563
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	VANFOSSAN
	Individual professional last name
Provider First Name	DONALD
	Individual professional first name
Provider Middle Name	D
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	NEUROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	201 CLINTON RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 106
	Group Practice or individual's line 2 address
City	JACKSON
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	956422678
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2092233021
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050014
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SUTTER AMADOR HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	051332
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MARK TWAIN MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	050335
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ADVENTIST HEALTH SONORA
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	M