Provider Demographics
NPI:1407842735
Name:VIGIL, GRETCHEN E (MD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:E
Last Name:VIGIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:E
Other - Last Name:GISSLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-8558
Mailing Address - Fax:319-356-4855
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-8558
Practice Address - Fax:319-356-4855
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33405208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA18411OtherWELLMARK BCBS
IA0210658Medicaid
H16040Medicare UPIN
IA18411OtherWELLMARK BCBS