Healthcare Provider Details

I. General information

NPI: 1437730108
Provider Name (Legal Business Name): NEIL HARRISON VIGIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14155 N 83RD AVE STE 110
PEORIA AZ
85381-5640
US

IV. Provider business mailing address

14155 N 83RD AVE STE 110
PEORIA AZ
85381-5640
US

V. Phone/Fax

Practice location:
  • Phone: 623-215-0911
  • Fax:
Mailing address:
  • Phone: 623-215-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number67158
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: