Provider Demographics
NPI:1194777425
Name:VANCE, ELDON L (DO)
Entity type:Individual
Prefix:
First Name:ELDON
Middle Name:L
Last Name:VANCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3949 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-4200
Mailing Address - Country:US
Mailing Address - Phone:419-423-3888
Mailing Address - Fax:419-423-4475
Practice Address - Street 1:3949 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-4200
Practice Address - Country:US
Practice Address - Phone:419-423-3888
Practice Address - Fax:419-423-4475
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002039208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2341184Medicaid
E25839Medicare UPIN
OH4088332Medicare PIN