Individual
DAVID M. AVANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
202 AGEE ST, FARMVILLE, VA 23901-2617
(434) 392-6143
(434) 392-3866
Mailing address
202 AGEE ST, FARMVILLE, VA 23901-2617
(434) 392-6143
(434) 392-3866
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
0110840639
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010223067
—
VA
01
—
10002776P
SENTARA/OPTIMA PROVIDER N
—
01
—
203639329
TRICARE PROVIDER NUMBER
—
Enumeration date
12/22/2005
Last updated
08/27/2013
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