Provider Demographics
NPI:1528005485
Name:VEGA-BERMUDEZ, FRANCISCO (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:FRANCISCO
Middle Name:
Last Name:VEGA-BERMUDEZ
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3891 RANCHERO DR STE 40
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2835
Mailing Address - Country:US
Mailing Address - Phone:734-773-4314
Mailing Address - Fax:410-740-1518
Practice Address - Street 1:96 SANDY BAY DR
Practice Address - Street 2:
Practice Address - City:POQUOSON
Practice Address - State:VA
Practice Address - Zip Code:23662-1028
Practice Address - Country:US
Practice Address - Phone:888-464-2466
Practice Address - Fax:410-740-1518
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012389612084N0600X, 2084S0012X
NY2511762084N0600X
FLME833632084N0600X
TXL72372084N0600X
WAMD000444802084N0600X
MDD520472084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00X982A01OtherMEDICARE PROVIDER #
WAG8877630Medicare PIN