MEDICARE: RICHARD W. VANIS, M.D., P.C.

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	G34782	CA

General Provider Information

NPI Number	:	1215934336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD W. VANIS, M.D., P.C.

Provider Business Mailing Address
First Line	:	301 W HUNTINGTON DR
Second Line	:	STE 617
City	:	ARCADIA
State	:	CA
Zip	:	91007-1518
Country	:	US
Telephone Number	:	626-574-9745
Fax Number	:	626-574-8741

Provider Business Practice Location Address
First Line	:	301 W HUNTINGTON DR
Second Line	:	STE 617
City	:	ARCADIA
State	:	CA
Zip	:	91007-1518
Country	:	US
Telephone Number	:	626-574-9745
Fax Number	:	626-574-8741

Authorized Official
Title or Position	:	ORTHOPEDIC SURGEON
Name	:	DR. RICHARD WILLIAM VANIS
Credential	:	M.D.
Telephone Number	:	626-574-9745

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	09/25/2008

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