Healthcare Provider Details

I. General information

NPI: 1447472071
Provider Name (Legal Business Name): VANCE WELLS BRABHAM IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 HENRY ST
GREENSBORO NC
27405-3633
US

IV. Provider business mailing address

1200 N ELM ST
GREENSBORO NC
27401-1004
US

V. Phone/Fax

Practice location:
  • Phone: 336-621-3777
  • Fax: 336-621-8374
Mailing address:
  • Phone: 336-832-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2008-00361
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number2008-00361
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: