Provider Demographics
NPI:1851037402
Name:UY, VANCE MIKHAIL TAN (MD)
Entity type:Individual
Prefix:MR
First Name:VANCE MIKHAIL
Middle Name:TAN
Last Name:UY
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 1:1325 N LITCHFIELD RD STE 110
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-1214
Mailing Address - Country:US
Mailing Address - Phone:602-568-1610
Mailing Address - Fax:
Practice Address - Street 1:1325 N LITCHFIELD RD STE 110
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-1214
Practice Address - Country:US
Practice Address - Phone:602-568-1610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2025-07-28
Deactivation Date:2022-12-13
Deactivation Code:
Reactivation Date:2022-12-20
Provider Licenses
StateLicense IDTaxonomies
AZ75633207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine