Provider Demographics
NPI:1194796920
Name:VERGARA, JOSE GERARDO (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:GERARDO
Last Name:VERGARA
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 1:18 PALMER ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-1346
Mailing Address - Country:US
Mailing Address - Phone:207-454-8195
Mailing Address - Fax:
Practice Address - Street 1:18 PALMER ST
Practice Address - Street 2:SUITE 3
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1346
Practice Address - Country:US
Practice Address - Phone:207-454-8195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55692207RG0100X
MEMD19527207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology