Provider Demographics
NPI:1700952751
Name:LAW, VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:LAW
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 1:859 AIRPORT DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-3443
Mailing Address - Country:US
Mailing Address - Phone:256-234-4295
Mailing Address - Fax:256-329-1024
Practice Address - Street 1:859 AIRPORT DRIVE
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3443
Practice Address - Country:US
Practice Address - Phone:256-234-4295
Practice Address - Fax:256-329-1024
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21966207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51096461OtherBCBS
AL009931820Medicaid
AL080179140OtherMEDICARE TRAVELERS
AL080179140OtherMEDICARE TRAVELERS
AL000096461Medicare ID - Type Unspecified