Provider Demographics
NPI:1699869081
Name:VIGIL, ANTHONY R (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:R
Last Name:VIGIL
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-5356
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:5550 WYOMING BLVD NE
Practice Address - Street 2:PMG WYOMING
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3167
Practice Address - Country:US
Practice Address - Phone:505-563-8464
Practice Address - Fax:505-563-8464
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-07-16
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Provider Licenses
StateLicense IDTaxonomies
NM76282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM4044Medicaid
E07864Medicare UPIN
NM4044Medicaid