Individual
DR. DAVID VANCE VANEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9395 W POCATELLO CREEK RD, POCATELLO, ID 83201-9049
(208) 232-1162
(208) 241-7575
Mailing address
9395 W POCATELLO CREEK RD, POCATELLO, ID 83201-9049
(208) 232-1162
(208) 232-1162
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M4597
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010005817
REGENCE BLUE SHIELD OF ID
ID
01
—
45971
BLUE CROSS OF IDAHO
ID
Enumeration date
09/14/2005
Last updated
07/08/2007
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