Provider Demographics
NPI:1336146679
Name:VEGA, SERGIO R (MD)
Entity type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:R
Last Name:VEGA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1500 N DIXIE HWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2712
Mailing Address - Country:US
Mailing Address - Phone:561-655-1889
Mailing Address - Fax:561-655-2868
Practice Address - Street 1:1500 N DIXIE HWY
Practice Address - Street 2:SUITE 206
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2712
Practice Address - Country:US
Practice Address - Phone:561-655-1889
Practice Address - Fax:561-655-2868
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2010-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME74502207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254048700Medicaid
G64945Medicare UPIN
E0282ZMedicare ID - Type Unspecified