MEDICARE: RONALD D VIGIL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	94159	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508950999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD D VIGIL MD

Provider Business Mailing Address
First Line	:	PO BOX 26666
Second Line	:	PHS PROVIDER ENROLLMENT
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87125-6666
Country	:	US
Telephone Number	:	505-923-5356
Fax Number	:	505-923-5354

Provider Business Practice Location Address
First Line	:	401 SAN MATEO BLVD SE
Second Line	:	PMG SAN MATEO
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-2921
Country	:	US
Telephone Number	:	505-462-6600
Fax Number	:	505-462-6641

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/17/2008

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