Provider Demographics
NPI:1235282823
Name:MEJIAS, VIVIAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:S
Last Name:MEJIAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11861 GRAND ISLES LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8372
Mailing Address - Country:US
Mailing Address - Phone:239-565-8822
Mailing Address - Fax:
Practice Address - Street 1:70 DUBOIS STREET
Practice Address - Street 2:ST LUKES HOSPITAL
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550
Practice Address - Country:US
Practice Address - Phone:845-561-4400
Practice Address - Fax:239-768-5385
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64545207L00000X, 207L00000X
OK34955207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3733351Medicaid
FL23215XMedicare ID - Type Unspecified
FL3733351Medicaid