Provider Demographics
NPI:1851603203
Name:DOCTOR ON CALL 4, LLC
Entity Type:Organization
Organization Name:DOCTOR ON CALL 4, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:VIGIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-873-4258
Mailing Address - Street 1:10753 PROSPECT AVE NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-3272
Mailing Address - Country:US
Mailing Address - Phone:505-873-4258
Mailing Address - Fax:505-873-4260
Practice Address - Street 1:1010 BRIDGE BLVD SW
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-3765
Practice Address - Country:US
Practice Address - Phone:505-873-4258
Practice Address - Fax:505-873-4260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM95-318207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty