Provider Demographics
NPI:1295816775
Name:VAGLEY, RICHARD THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:THOMAS
Last Name:VAGLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 MAJORCA AVENUE
Mailing Address - Street 2:UNIT 202
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4325
Mailing Address - Country:US
Mailing Address - Phone:305-362-8678
Mailing Address - Fax:
Practice Address - Street 1:SPECTRUM AESTHETICS
Practice Address - Street 2:51 SW 42ND AVENUE
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1770
Practice Address - Country:US
Practice Address - Phone:305-514-0358
Practice Address - Fax:866-572-1427
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD011041E208200000X
TXS4408208200000X
FLME138014208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA390055Medicaid
PA390055Medicaid
PAVA078158Medicare ID - Type Unspecified