Provider Demographics
NPI:1881675544
Name:VAGIAS, LOUIS II (MD)
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:
Last Name:VAGIAS
Suffix:II
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 1:2190 HIGHWAY 85 N
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1045
Mailing Address - Country:US
Mailing Address - Phone:850-729-9407
Mailing Address - Fax:850-729-9418
Practice Address - Street 1:2190 HIGHWAY 85 N
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1045
Practice Address - Country:US
Practice Address - Phone:850-729-9407
Practice Address - Fax:850-729-9418
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74009207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252313200Medicaid
FLG64827Medicare UPIN
FL252313200Medicaid