Provider Demographics
NPI:1396753521
Name:VARGAS, ALFREDO (MD)
Entity type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:
Last Name:VARGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-2006
Mailing Address - Country:US
Mailing Address - Phone:720-524-1550
Mailing Address - Fax:720-524-1551
Practice Address - Street 1:945 DESERT FLOWER BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1181
Practice Address - Country:US
Practice Address - Phone:719-545-5321
Practice Address - Fax:719-545-0096
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32927207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01329275Medicaid
CO01329275Medicaid
92171Medicare ID - Type Unspecified