Provider Demographics
NPI:1518991009
Name:NIELSEN, VANCE G (MD)
Entity Type:Individual
Prefix:
First Name:VANCE
Middle Name:G
Last Name:NIELSEN
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 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:619 19TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-934-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14170207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010033CE34209OtherSECTION 1011
MS01353090OtherMISSISSIPPI MEDICAID
AL000083106Medicaid
AL051511211OtherBLUE CROSS
AL26595OtherHEALTHSPRING OF ALABAMA
ALP00070183OtherRAILROAD MEDICARE
AL000083106OtherBLUE CROSS
ALE34209OtherVIVA
AL000083106Medicare ID - Type Unspecified