Provider Demographics
NPI:1871584185
Name:ANSLEY, VINCENT A (MD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:A
Last Name:ANSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 E YOSEMITE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8218
Mailing Address - Country:US
Mailing Address - Phone:209-383-3990
Mailing Address - Fax:209-383-2082
Practice Address - Street 1:3144 N G STREET #125
Practice Address - Street 2:PMB 293
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340
Practice Address - Country:US
Practice Address - Phone:209-383-3990
Practice Address - Fax:209-383-2082
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41598207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G415980OtherBLUE SHIELD
CA00G415980Medicaid
CA00G415983Medicare ID - Type Unspecified
CA00G415980Medicaid