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Provider Information for 1740544923



DR. PATRICK BRANDON VICKERS D.O

Gender: MALE

Individual NPI: 1740544923

Calendar Last Updated: 2015-04-09

Details

Name Value
NPI 1740544923
Enumeration Date 2012-07-02
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 142 S MAIN ST
DANVILLE, VA 24541-2922
United States

Phone: 434-799-3859 | Fax: 434-773-6803
View Map External Link
Primary Practice Address 1955 MEMORIAL DR
DANVILLE, VA 24541-4712
United States

Phone: 434-799-2055 | Fax: 434-799-2044
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 207R00000X - Internal Medicine VA 0116025122
No 207R00000X - Internal Medicine VA 0102203852