Provider Demographics
NPI:1144388349
Name:VIX, VERNON A JR (MD)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:A
Last Name:VIX
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3868
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47737-3868
Mailing Address - Country:US
Mailing Address - Phone:812-474-7123
Mailing Address - Fax:812-858-4545
Practice Address - Street 1:421 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1227
Practice Address - Country:US
Practice Address - Phone:812-474-7123
Practice Address - Fax:812-858-4545
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037267A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000109456OtherINDIANA ANTHEM
IN100088450Medicaid
KY64870207OtherKY MEDICAID
IN257900NNNMedicare PIN
INC95614Medicare UPIN
IN100088450Medicaid
IN000000109456OtherINDIANA ANTHEM