Basic Information
| Provider Information | |||||||||
| NPI: | 1447472071 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRABHAM | ||||||||
| FirstName: | VANCE | ||||||||
| MiddleName: | WELLS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | IV | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 N ELM ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368327000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2704 HENRY ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274053633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366213777 | ||||||||
| FaxNumber: | 3366218374 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 08/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 2008-00361 | NC | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | 2008-00361 | NC | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.