Provider Demographics
NPI:1689764060
Name:VEGA, TAMARA MELISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:MELISSA
Last Name:VEGA
Suffix:
Gender:F
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:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-733-0477
Mailing Address - Fax:352-733-0371
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-733-0477
Practice Address - Fax:352-733-0371
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90861207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273063400Medicaid
I16837Medicare UPIN
FL01739ZMedicare ID - Type Unspecified
01739ZMedicare PIN
FL273063400Medicaid