Provider Demographics
NPI:1427074780
Name:VANCE, MARK B (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:B
Last Name:VANCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-2755
Mailing Address - Fax:239-424-2756
Practice Address - Street 1:708 DEL PRADO BLVD S STE 6
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990
Practice Address - Country:US
Practice Address - Phone:239-424-2755
Practice Address - Fax:239-424-2756
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS15765208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101721600Medicaid
MI114592330Medicaid
MI5251032OtherBLUE CARE NETWORK
MI5251032OtherBLUE CROSS
MI7420565OtherAETNA
MI0998650OtherGENESEE HEALTH PLAN
MI139094OtherPREFERRED CHOICE
MI382626202OtherCARE CHOICES
MI0998650OtherHEALTH PLUS
MI0N89830001OtherBLUE CROSS MEDICARE ADVAN
MI1427074780OtherHEALTH ALLIANCE PLAN
MIP00271698OtherPALMETTO GBA - RR MEDICAR
MI1015760OtherMCLAREN HEALTH PLAN
MI16587OtherMCARE