Provider Demographics
NPI:1871773572
Name:DEBORAH D. VIGLIONE M.D., LLC
Entity type:Organization
Organization Name:DEBORAH D. VIGLIONE M.D., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:VIGLIONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-934-8138
Mailing Address - Street 1:103 NIGHTINGALE LN
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-7205
Mailing Address - Country:US
Mailing Address - Phone:850-934-8138
Mailing Address - Fax:850-934-6667
Practice Address - Street 1:103 NIGHTINGALE LN
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-7205
Practice Address - Country:US
Practice Address - Phone:850-934-8138
Practice Address - Fax:850-934-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65188207R00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23860YOtherMEDICARE
FLF25157Medicare UPIN