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Individual
MARK EDWARD VIG
Active
Individual
MARK EDWARD VIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
55603
WI
207R00000X
Internal Medicine Physician
Primary
Q8380
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
369865601
—
TX
01
—
75-2616977-007
TRICARE
TX
01
—
8GK658
BCBS
TX
Enumeration date
04/13/2009
Last updated
06/09/2017
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