Doctor Name: | JOHN ADAM VANN |
NPI Number: | 1225257629 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | PA767 |
Business Practice Address: | 300 S. Twining Str Bldg 760 Maxwell Afb, AL - 36112 |
Business Phone Number: | 3349537290 |
Business Fax Number: | |
Mailing Address: | 7436 Mill Ridge Ct, MONTGOMERY |
State: | AL |
Postal Code: | 361174785 |
Phone Number: | 7067189732 |
Fax Number: | |
NPI Enumeration Date: | 04/24/2007 |
NPI Last Update Date: | 11/07/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA767 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |