Provider Demographics
NPI:1427074772
Name:VANCE, JOHN E (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:E
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 1:8235 N HOLLY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2441
Mailing Address - Country:US
Mailing Address - Phone:810-694-9700
Mailing Address - Fax:810-694-9940
Practice Address - Street 1:8235 N HOLLY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2441
Practice Address - Country:US
Practice Address - Phone:810-694-9700
Practice Address - Fax:810-694-9940
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012733208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0987785OtherGENESEE HEALTH PLAN
MI0989830003OtherBLUE CROSS MEDICARE ADVAN
MI5250193OtherBLUE CROSS
MI5250193OtherBLUE CARE NETWORK
MI114190217Medicaid
MI7292237OtherAETNA
MIC7107OtherMCARE
MI1006245OtherMCLAREN HEALTH PLAN
MI127401OtherPREFERRED CHOICE
MI382626202OtherCARE CHOICES
MI020046189OtherPALMETTO GBA - RR MEDICAR
MIH13883OtherHAP
MI0987785OtherHEALTH PLUS
MI114190217Medicaid