Individual
KERRY DEAN VANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 S WOODWORTH LOOP, PALMER, AK 99645-8984
(907) 375-3355
(907) 375-3351
Mailing address
4300 B ST STE 200, ANCHORAGE, AK 99503-5933
(907) 375-3355
(907) 375-3351
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2012025753
MO
207Q00000X
Family Medicine Physician
7596
AK
207Q00000X
Family Medicine Physician
H5367
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1314130-08
—
TX
01
—
1314130-09
CSHCN
TX
05
—
131413010
—
TX
01
—
8CD653
BC/BS
TX
01
—
8U1465
BLUE SHIELD
TX
Enumeration date
04/05/2006
Last updated
04/08/2017
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