Provider Demographics
NPI:1316927577
Name:VINCENT, JAMES S (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:S
Last Name:VINCENT
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:PO BOX 200993
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-0993
Mailing Address - Country:US
Mailing Address - Phone:281-784-1111
Mailing Address - Fax:281-784-1555
Practice Address - Street 1:301 MEDIC LN
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-5542
Practice Address - Country:US
Practice Address - Phone:281-331-6141
Practice Address - Fax:281-331-3316
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5172207P00000X, 207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164913905Medicaid
TX1316927577OtherTRICARE SOUTH
TX164913904Medicaid
TX164913906Medicaid
TX8G6289OtherBC/BS PROVIDER NUMBER
TX164913904Medicaid
TX1316927577Medicare PIN
TXH81014Medicare UPIN
TX8D6358Medicare PIN
TX1316927577OtherTRICARE SOUTH
TX8D6879Medicare PIN