Provider Demographics
NPI:1457616245
Name:VARGAS MARTINEZ, DAVID JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOSE
Last Name:VARGAS MARTINEZ
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 1:14616 STATE ROAD 70 E
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-8413
Mailing Address - Country:US
Mailing Address - Phone:941-909-7755
Mailing Address - Fax:
Practice Address - Street 1:14616 STATE ROAD 70 E
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-8413
Practice Address - Country:US
Practice Address - Phone:941-909-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT202566207Q00000X
FLME135604207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine