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1134110828

NPI Code Detail

MEDICARE: DR. PETER WILLIAM VANN MD

MEDICARE: DR. PETER WILLIAM VANN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	13430	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	453051001	OTHER	AZ	GROUP HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	860373636	OTHER	AZ	HUMANA
4	AW1436	OTHER	AZ	HEALTHNET
5	3981220	OTHER	AZ	EYECARE
6	AZ0728670	OTHER	AZ	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1134110828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER WILLIAM VANN MD

Provider Business Mailing Address
First Line	:	9144 S DROMEDARY DR
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85284-3001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 W BETHANY HOME RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-2443
Country	:	US
Telephone Number	:	602-249-0212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	06/29/2010

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Directions to “ DR. PETER WILLIAM VANN MD” Practice Location

Language	Start Address	Practice Location

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