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NPI Code Detail

MEDICARE: KERRY DEAN VANCE M.D.

MEDICARE: KERRY DEAN VANCE M.D.
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
1207Q00000XFamily Medicine PhysicianH5367TX
2207Q00000XFamily Medicine Physician2012025753MO
3207Q00000XFamily Medicine Physician7596AK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28U1465OTHERTXBLUE SHIELD
38CD653OTHERTXBC/BS
41314130-09OTHERTXCSHCN
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699737692
Entity Type Code : Individual
Provider Name (Legal Business Name) : KERRY DEAN VANCE M.D.
Provider Business Mailing Address
First Line : 4300 B ST STE 200
Second Line :
City : ANCHORAGE
State : AK
Zip : 99503-5933
Country : US
Telephone Number : 907-375-3355
Fax Number : 907-375-3351
Provider Business Practice Location Address
First Line : 2500 S WOODWORTH LOOP
Second Line :
City : PALMER
State : AK
Zip : 99645-8984
Country : US
Telephone Number : 907-375-3355
Fax Number : 907-375-3351
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2006
Last Update Date : 04/08/2017

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Directions to “ KERRY DEAN VANCE M.D.” Practice Location

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