Provider Demographics
NPI:1396182267
Name:VIGIL, PATRICK DANIEL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:DANIEL
Last Name:VIGIL
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S UNION AVE STE 4003
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1702
Mailing Address - Country:US
Mailing Address - Phone:253-693-0071
Mailing Address - Fax:253-693-0071
Practice Address - Street 1:1901 S UNION AVE STE 4003
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1702
Practice Address - Country:US
Practice Address - Phone:253-693-0071
Practice Address - Fax:618-481-2593
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML60375676207Q00000X
WAMD60577167207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2029841Medicaid
WAG8943220Medicare PIN
WA2029841Medicaid