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General NPI Number Information
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NPI Number | 1417397076
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Entity Type | Individual
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Provider Name | THOMAS BLAKE VINCENT D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2013
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 3400 NEW HARTFORD RD
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City | OWENSBORO
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State | KY
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Zip | 42303-2058
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Country | US
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Telephone | 270-684-5034
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1244
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City | HENDERSON
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State | KY
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Zip | 42419-1244
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Country | US
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Telephone | 812-465-6202
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Fax | 812-474-3622
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 03709
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R3058
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License Number State | KY
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