Individual
DR. VANCE EDWARD ZACHARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4420 IRVING BLVD NW, ALBUQUERQUE, NM 87114-5915
(505) 727-6300
(505) 727-9588
Mailing address
4420 IRVING BLVD NW, ALBUQUERQUE, NM 87114-5915
(505) 727-6300
(505) 727-9588
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
G7610
TX
207Q00000X
Family Medicine Physician
Primary
MD2015-0091
NM
207QS0010X
Sports Medicine (Family Medicine) Physician
G7610
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
25156772
—
NM
01
—
401311YR41
MEDICARE NUMBER
NM
Enumeration date
03/29/2006
Last updated
02/05/2016
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