Healthcare Provider Details

I. General information

NPI: 1487974192
Provider Name (Legal Business Name): RALPH BROOKS VANCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BAPTIST MEMORIAL CIR STE 204
OXFORD MS
38655-0538
US

IV. Provider business mailing address

350 N HUMPHREYS BLVD
MEMPHIS TN
38120-2177
US

V. Phone/Fax

Practice location:
  • Phone: 662-636-2451
  • Fax: 662-636-2290
Mailing address:
  • Phone: 901-226-4003
  • Fax: 901-227-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number24918
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: