Doctor Name: | DR. JOHNNIE R VIGIL |
NPI Number: | 1285762377 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 89-319 |
Business Practice Address: | 10700 Menaul Blvd Ne Suite C Albuquerque, NM - 871122437 |
Business Phone Number: | 5053238911 |
Business Fax Number: | 5052943305 |
Mailing Address: | 10753 Prospect Ave Ne, Suite B ALBUQUERQUE |
State: | NM |
Postal Code: | 871123272 |
Phone Number: | 5053238911 |
Fax Number: | 5052943305 |
NPI Enumeration Date: | 03/01/2007 |
NPI Last Update Date: | 10/15/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 89-319 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |