Provider Demographics
NPI:1215925441
Name:VANIG, THANES JASON (MD)
Entity type:Individual
Prefix:
First Name:THANES
Middle Name:JASON
Last Name:VANIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 E MONTEREY WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2628
Mailing Address - Country:US
Mailing Address - Phone:602-604-9500
Mailing Address - Fax:602-631-9303
Practice Address - Street 1:52 E MONTEREY WAY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012
Practice Address - Country:US
Practice Address - Phone:602-604-9500
Practice Address - Fax:602-631-9303
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ4503363AM0700X
AZ24745207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ382763Medicaid
AZ479929Medicaid
AZ382763Medicaid
AZ860873744OtherTAX ID