Provider Demographics
NPI:1538110309
Name:VINCENT, BRUCE S (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:S
Last Name:VINCENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:444 CLINCHFIELD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3858
Mailing Address - Country:US
Mailing Address - Phone:423-230-2500
Mailing Address - Fax:423-230-2510
Practice Address - Street 1:444 CLINCHFIELD ST STE 2500
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3858
Practice Address - Country:US
Practice Address - Phone:423-230-2500
Practice Address - Fax:423-230-2510
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD27961207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN62158439125OtherJOHN DEERE
TNCA4007OtherMEDICARE RAILROAD
TN1337280OtherBLACK LUNG
TN4095899OtherBLUE CROSS BLUE SHIELD
VA281048OtherBLUE CROSS BLUE SHIELD
TN209176OtherUMWA
VA5619840OtherMEDICAID
TN3804526Medicaid
VA281048OtherBLUE CROSS BLUE SHIELD
TN4095899OtherBLUE CROSS BLUE SHIELD