Provider Demographics
NPI:1629030861
Name:VARGAS, CARLOS E (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:E
Last Name:VARGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:E
Other - Last Name:VARGAS MONCALEANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:13400 E SHEA BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5452
Mailing Address - Country:US
Mailing Address - Phone:480-301-8000
Mailing Address - Fax:
Practice Address - Street 1:13400 E SHEA BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-5452
Practice Address - Country:US
Practice Address - Phone:480-301-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME936632085R0001X
AZ496042085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL298604OtherAVMED
FL16087OtherBCBS OF FLORIDA
GA772075324AMedicaid
FL2732394-00Medicaid
GA772075324AMedicaid
FL16807VMedicare PIN
FL16807QMedicare PIN
FL16807MMedicare PIN
FL2732394-00Medicaid
FL16807RMedicare PIN
FL16807NMedicare PIN
FLI41031Medicare UPIN
FL16807UMedicare PIN
FL16807LMedicare PIN
FL16087OtherBCBS OF FLORIDA
FL16807PMedicare PIN