Provider Demographics
NPI:1760567762
Name:VEGA, GEORGE L (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:L
Last Name:VEGA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:400 E BAY ST STE 606
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-2948
Mailing Address - Country:US
Mailing Address - Phone:904-556-3991
Mailing Address - Fax:904-356-8027
Practice Address - Street 1:4933 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5935
Practice Address - Country:US
Practice Address - Phone:904-733-7800
Practice Address - Fax:904-419-4888
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2013-02-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME513642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology