Provider Demographics
NPI:1730133745
Name:VEGA, DAVID T (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:T
Last Name:VEGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4143 CARMICHAEL RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2803
Mailing Address - Country:US
Mailing Address - Phone:334-395-2200
Mailing Address - Fax:334-395-2290
Practice Address - Street 1:1023 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6750
Practice Address - Country:US
Practice Address - Phone:334-273-7000
Practice Address - Fax:334-273-2386
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL246662085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009900465Medicaid
AL009935641Medicaid
AL05155792Medicaid
4248810003Medicare NSC
4248810001Medicare NSC
051551792Medicare PIN
AL009900465Medicaid
AL009935641Medicaid
4248810004Medicare NSC