Provider Demographics
NPI:1669493433
Name:VEGA, HECTOR L (PAC)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:L
Last Name:VEGA
Suffix:
Gender:M
Credentials:PAC
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 63
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37815-0063
Mailing Address - Country:US
Mailing Address - Phone:423-307-1468
Mailing Address - Fax:423-307-1479
Practice Address - Street 1:210 E ECONOMY RD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814
Practice Address - Country:US
Practice Address - Phone:423-307-1468
Practice Address - Fax:423-307-1479
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000000475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
S19103Medicare UPIN