Provider Demographics
NPI:1154470532
Name:VEGA, GERALD B JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:B
Last Name:VEGA
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:14822 HARTFORD RUN DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7824
Mailing Address - Country:US
Mailing Address - Phone:407-924-4863
Mailing Address - Fax:407-823-2546
Practice Address - Street 1:4000 CENTRAL FLORIDA BLVD
Practice Address - Street 2:BUILDING 127
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32816-3333
Practice Address - Country:US
Practice Address - Phone:407-823-2097
Practice Address - Fax:407-823-2546
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2011-06-20
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Provider Licenses
StateLicense IDTaxonomies
FL003604363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant