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General NPI Number Information
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NPI Number | 1003802265
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Entity Type | Individual
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Provider Name | ALIX VINCENT MD
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Gender | Male
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Dates
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Enumeration Date | 09/23/2005
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 8201 E RIVERSIDE BLVD
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City | ROCKFORD
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State | IL
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Zip | 61114-2300
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Country | US
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Telephone | 815-971-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 3 SEA COVE LN
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-6221
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Country | US
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Telephone | 909-838-7864
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | W0351
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME97645
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | C1-0025029
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License Number State | DE
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Taxonomy #4
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 225547
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License Number State | MA
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