Healthcare Provider Details

I. General information

NPI: 1326397829
Provider Name (Legal Business Name): JONATHON F VIGIL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7280 LAGAE RD STE J
CASTLE PINES CO
80108-9454
US

IV. Provider business mailing address

1805 SHEA CENTER DR STE 450
HIGHLANDS RANCH CO
80129-2255
US

V. Phone/Fax

Practice location:
  • Phone: 303-814-0505
  • Fax: 303-814-6491
Mailing address:
  • Phone: 303-357-2559
  • Fax: 303-814-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2012-0053
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0007116
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: