Provider Demographics
NPI:1609201334
Name:MARTY VIGO, HARRY D (MD)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:D
Last Name:MARTY VIGO
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 1:15255 MAX LEGGETT PKWY 4TH FLOOR STE 4224
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218
Mailing Address - Country:US
Mailing Address - Phone:904-427-4252
Mailing Address - Fax:904-427-6727
Practice Address - Street 1:15255 MAX LEGGETT PKWY STE 4224
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-7275
Practice Address - Country:US
Practice Address - Phone:904-427-4252
Practice Address - Fax:904-427-6727
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA90708207R00000X
FLME134756207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine