Provider Demographics
NPI:1801893821
Name:VIGIL, JACOB PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:PATRICK
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 1:7005 SAN MARINO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1507
Mailing Address - Country:US
Mailing Address - Phone:915-842-0523
Mailing Address - Fax:
Practice Address - Street 1:2001 N OREGON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3320
Practice Address - Country:US
Practice Address - Phone:915-577-6551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5046207P00000X
LAMD.205532207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine