Provider Demographics
NPI:1689619405
Name:VIG, VIBHA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIBHA
Middle Name:
Last Name:VIG
Suffix:
Gender:F
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 626
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-0626
Mailing Address - Country:US
Mailing Address - Phone:601-855-5287
Mailing Address - Fax:601-855-5130
Practice Address - Street 1:SUNSHINE MEDICAL CLINIC
Practice Address - Street 2:1883 HWY 43 S. SUITE G
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046
Practice Address - Country:US
Practice Address - Phone:601-855-5287
Practice Address - Fax:601-855-5130
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13655208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115515Medicaid