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Individual
VANCE R JERNSTROM
Active
Individual
VANCE R JERNSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
04-21322
KS
207Y00000X
Otolaryngology Physician
19023
NE
207Y00000X
Otolaryngology Physician
Primary
R5C10
MO
Other
Enumeration date
03/24/2006
Last updated
03/28/2012
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