Provider Demographics
NPI:1528374550
Name:SILVA-VEGA, ALEXIS (MD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:SILVA-VEGA
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 1:2020 FLAMINGO DR
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-4262
Mailing Address - Country:US
Mailing Address - Phone:863-533-4104
Mailing Address - Fax:863-553-4549
Practice Address - Street 1:2020 FLAMINGO DR
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-4262
Practice Address - Country:US
Practice Address - Phone:863-533-4104
Practice Address - Fax:863-553-4549
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20742207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine