Provider Demographics
NPI:1346223211
Name:VIGIL, JUSTIN JOAQUIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:JOAQUIN
Last Name:VIGIL
Suffix:
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 1:19141 STONE OAK PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3367
Mailing Address - Country:US
Mailing Address - Phone:866-384-5470
Mailing Address - Fax:866-384-5471
Practice Address - Street 1:14800 SAN PEDRO AVE STE 115
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3734
Practice Address - Country:US
Practice Address - Phone:866-384-5470
Practice Address - Fax:866-384-5471
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6206208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157837903Medicaid
TX157837903Medicaid
8F1642Medicare PIN