Provider Demographics
NPI:1841506870
Name:VINCENT, JEAN HILAIRE (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:HILAIRE
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 1077
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35631-1077
Mailing Address - Country:US
Mailing Address - Phone:256-444-4401
Mailing Address - Fax:
Practice Address - Street 1:22281 US HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35613-2600
Practice Address - Country:US
Practice Address - Phone:256-444-4401
Practice Address - Fax:256-444-4403
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL36985207R00000X, 207RI0200X
WI64061207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL223108Medicaid