MEDICARE: DANIEL B VANCE IV 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	207R00000X	Internal Medicine Physician	12815	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4178405	OTHER	SD	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	4178405	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1932173028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL B VANCE IV MD

Provider Business Mailing Address
First Line	:	1060 PEERLESS CROSSING DR
Second Line	:	SUITE 200
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3785
Country	:	US
Telephone Number	:	423-479-4165
Fax Number	:	423-478-1884

Provider Business Practice Location Address
First Line	:	1060 PEERLESS CROSSING DR
Second Line	:	SUITE 200
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3785
Country	:	US
Telephone Number	:	423-479-4165
Fax Number	:	423-478-1884

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	09/04/2020

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