Active NPI
David Vance Vanek, M.D.
- Surgery Physician
- Pocatello, ID
National Provider Identifier
1689669772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- M4597
- Practice address
- 9395 W Pocatello Creek Rd
Pocatello, ID 83201-9049 - Phone
- (208) 232-1162
- Fax
- (208) 241-7575
- NPI assigned
- Sep 14, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | M4597 | ID | Primary |
Addresses
Primary practice location
9395 W Pocatello Creek Rd
Pocatello, ID 83201-9049
Mailing address
9395 W Pocatello Creek Rd
Pocatello, ID 83201-9049
Phone (208) 232-1162
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010005817 | Other | ID | REGENCE BLUE SHIELD OF ID |
| 45971 | Other | ID | BLUE CROSS OF IDAHO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M4597 | ID | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689669772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9395 W POCATELLO CREEK RD",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832019049",
"telephone_number": "208-232-1162",
"fax_number": "208-232-1162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9395 W POCATELLO CREEK RD",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832019049",
"telephone_number": "208-232-1162",
"fax_number": "208-241-7575"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANEK",
"first_name": "DAVID",
"middle_name": "VANCE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "ID",
"license": "M4597",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD OF ID",
"identifier": "000010005817",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF IDAHO",
"identifier": "45971",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.