Provider Demographics
NPI:1396720116
Name:VIGNERI, JOSEPH M (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:VIGNERI
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 1:6500 E 2ND ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4338
Mailing Address - Country:US
Mailing Address - Phone:307-577-4240
Mailing Address - Fax:307-577-0012
Practice Address - Street 1:6500 E 2ND ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609
Practice Address - Country:UM
Practice Address - Phone:307-577-4240
Practice Address - Fax:307-577-0012
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2378A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY301831OtherBLUE CROSS BLUIE SHIELD
WY040004052OtherRAILROAD MEDICARE
WY101580000Medicaid
WY101580000Medicaid
WY301831Medicare ID - Type Unspecified