Individual
THANES JASON VANIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
52 E MONTEREY WAY, PHOENIX, AZ 85012
(602) 604-9500
(602) 631-9303
Mailing address
52 E MONTEREY WAY, PHOENIX, AZ 85012-2628
(602) 604-9500
(602) 631-9303
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
24745
AZ
363AM0700X
Medical Physician Assistant
AZ4503
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
382763
—
AZ
05
—
479929
—
AZ
Enumeration date
10/11/2005
Last updated
08/09/2018
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