Provider Demographics
NPI:1235101700
Name:VERO VASCULAR SURGERY PA
Entity Type:Organization
Organization Name:VERO VASCULAR SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:BECKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-567-6602
Mailing Address - Street 1:3770 7TH TER
Mailing Address - Street 2:#101
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6553
Mailing Address - Country:US
Mailing Address - Phone:772-567-6602
Mailing Address - Fax:772-567-7754
Practice Address - Street 1:3770 7TH TER
Practice Address - Street 2:#101
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6553
Practice Address - Country:US
Practice Address - Phone:772-567-6602
Practice Address - Fax:772-567-7754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72535OtherBLUE CROSS BLUE SHIELD
FLK1068Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER