Individual
VANCE EUGENE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
695 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2321
(386) 258-8722
(386) 258-8659
Mailing address
695 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2321
(386) 258-8722
(386) 258-8659
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
ME0062094
FL
207RI0011X
Interventional Cardiology Physician
Primary
ME0062094
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15073
BCBS
FL
05
—
370394100
—
FL
Enumeration date
03/27/2006
Last updated
10/10/2018
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