Provider Demographics
NPI:1750302873
Name:VIGIL, LUIS H (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:H
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 1:205 BENTON DR APT 9111
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-1163
Mailing Address - Country:US
Mailing Address - Phone:214-205-2223
Mailing Address - Fax:214-324-3057
Practice Address - Street 1:430 N MONTE VISTA ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4610
Practice Address - Country:US
Practice Address - Phone:580-332-8846
Practice Address - Fax:580-421-1208
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238880207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10416922Medicaid
VA0101238880OtherVIRGINIA MEDICAL LIC
VA016292S95Medicare PIN