Provider Demographics
NPI:1376746305
Name:VARGO, JACOB A (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:A
Last Name:VARGO
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1129 HALE ROAD
Mailing Address - Street 2:MEMPHIS CHILDRENS CLINIC
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116
Mailing Address - Country:US
Mailing Address - Phone:901-396-0390
Mailing Address - Fax:901-396-8151
Practice Address - Street 1:1129 HALE ROAD
Practice Address - Street 2:MEMPHIS CHILDRENS CLINIC
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116
Practice Address - Country:US
Practice Address - Phone:901-396-0390
Practice Address - Fax:901-396-8151
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2008-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN43627208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics