Healthcare Provider Details

I. General information

NPI: 1194729020
Provider Name (Legal Business Name): DANIEL ROBERT VIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 BLUE RIDGE RD STE 503
RALEIGH NC
27607-6477
US

IV. Provider business mailing address

2800 BLUE RIDGE RD STE 503
RALEIGH NC
27607-6477
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-8210
  • Fax: 919-781-4650
Mailing address:
  • Phone: 919-782-8210
  • Fax: 919-781-4650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number9901069
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: