Provider Demographics
NPI:1083768907
Name:VARGAS, PURA G (MD)
Entity Type:Individual
Prefix:
First Name:PURA
Middle Name:G
Last Name:VARGAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PURA
Other - Middle Name:G
Other - Last Name:GARIN-VARGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:38 EXECUTIVE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857
Mailing Address - Country:US
Mailing Address - Phone:419-668-8881
Mailing Address - Fax:419-668-0668
Practice Address - Street 1:38 EXECUTIVE DRIVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857
Practice Address - Country:US
Practice Address - Phone:419-668-8881
Practice Address - Fax:419-668-0668
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35032040207LP2900X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0144356Medicaid
OH000000128808OtherANTHEM
D31854Medicare UPIN
OH0144356Medicaid