Provider Demographics
NPI:1427074780
Name:VANCE, MARK B (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:B
Last Name:VANCE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-2755
Mailing Address - Fax:239-424-2756
Practice Address - Street 1:8380 RIVERWALK PARK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-8758
Practice Address - Country:US
Practice Address - Phone:239-343-9960
Practice Address - Fax:239-343-9977
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2025-08-04
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Provider Licenses
StateLicense IDTaxonomies
FLOS15765208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI16587OtherMCARE
MIP00271698OtherPALMETTO GBA - RR MEDICAR
MI139094OtherPREFERRED CHOICE
MI382626202OtherCARE CHOICES
MI5251032OtherBLUE CROSS
MI7420565OtherAETNA
MI0998650OtherHEALTH PLUS
MI0998650OtherGENESEE HEALTH PLAN
MI0N89830001OtherBLUE CROSS MEDICARE ADVAN
MI1015760OtherMCLAREN HEALTH PLAN
MI1427074780OtherHEALTH ALLIANCE PLAN
MI114592330Medicaid
FL101721600Medicaid
MI5251032OtherBLUE CARE NETWORK