Provider Demographics
NPI:1104213412
Name:VANCE, BRYCE ALSTON (DO)
Entity type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:ALSTON
Last Name:VANCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2601 GENE GEORGE BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-0845
Mailing Address - Country:US
Mailing Address - Phone:479-309-5391
Mailing Address - Fax:479-725-6582
Practice Address - Street 1:2601 GENE GEORGE BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0845
Practice Address - Country:US
Practice Address - Phone:479-309-5391
Practice Address - Fax:479-725-6582
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0059282208000000X, 2080A0000X
ARE-196522080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatrics