Provider Demographics
NPI:1164728630
Name:G. E. VEGA, M. D., P. A.
Entity Type:Organization
Organization Name:G. E. VEGA, M. D., P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:ELI
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-870-1404
Mailing Address - Street 1:PO BOX 271058
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33688-1058
Mailing Address - Country:US
Mailing Address - Phone:813-870-1404
Mailing Address - Fax:813-870-3479
Practice Address - Street 1:4600 N HABANA AVE
Practice Address - Street 2:SUITE 33
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7112
Practice Address - Country:US
Practice Address - Phone:813-870-1404
Practice Address - Fax:813-870-3479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 21412174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054821900Medicaid
FL29831Medicare PIN
FL054821900Medicaid