Provider Demographics
NPI:1275527038
Name:VERA, ARNOLD (MD, MSC, FACE)
Entity Type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:
Last Name:VERA
Suffix:
Gender:M
Credentials:MD, MSC, FACE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 741240
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32774-1240
Mailing Address - Country:US
Mailing Address - Phone:386-774-5211
Mailing Address - Fax:386-774-5251
Practice Address - Street 1:1667 N CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5500
Practice Address - Country:US
Practice Address - Phone:386-274-1414
Practice Address - Fax:386-274-2215
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76414207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
59-3622303OtherTAX ID
FLDE7637OtherRAILROAD MEDICARE
FL46238OtherBLUE CROSS BLUE SHIELD
FL460003036OtherRAILROAD MEDICARE
FL255756800Medicaid
FL255756800Medicaid
FLF34342Medicare UPIN