Provider Demographics
NPI:1841375193
Name:VERA ENDOCRINE ASSOCIATES INC
Entity type:Organization
Organization Name:VERA ENDOCRINE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KITTY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-274-1414
Mailing Address - Street 1:1667 N CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5500
Mailing Address - Country:US
Mailing Address - Phone:386-274-1414
Mailing Address - Fax:386-274-2215
Practice Address - Street 1:1667 N CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5500
Practice Address - Country:US
Practice Address - Phone:386-274-1414
Practice Address - Fax:386-274-2215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1275527038OtherNPI
FL255756800Medicaid
FL255756800Medicaid
FLF34342Medicare UPIN
FLK1545Medicare ID - Type Unspecified