Provider Demographics
NPI:1306820147
Name:VARGAS, JOSE M L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE M
Middle Name:L
Last Name:VARGAS
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:PO BOX 1179
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-1179
Mailing Address - Country:US
Mailing Address - Phone:787-892-1899
Mailing Address - Fax:787-264-0355
Practice Address - Street 1:OFICINA 107 METROPOLITAN PLAZA
Practice Address - Street 2:100 HERNAN ALVAREZ ST
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6478208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD08574Medicare UPIN