MEDICARE: DR. TOMAS E VIGO PAREDES 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	17682	WV
2	208D00000X	General Practice Physician	17682	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17682	OTHER	WV	WV MEDICAL LICENSE

General Provider Information

NPI Number	:	1851395834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOMAS E VIGO PAREDES MD

Provider Business Mailing Address
First Line	:	132 GILCHRIST AVE
Second Line	:
City	:	TORNADO
State	:	WV
Zip	:	25202-9640
Country	:	US
Telephone Number	:	304-687-0054
Fax Number	:	304-855-2245

Provider Business Practice Location Address
First Line	:	40 SHAE AVE
Second Line	:
City	:	CHAPMANVILLE
State	:	WV
Zip	:	25508-9805
Country	:	US
Telephone Number	:	304-855-2211
Fax Number	:	304-855-2213

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	04/10/2019

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