Provider Demographics
NPI:1912221425
Name:VEGA, RUSSELL SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:SCOTT
Last Name:VEGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2001 SIESTA DR STE 302
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5200
Mailing Address - Country:US
Mailing Address - Phone:941-361-6909
Mailing Address - Fax:941-361-6914
Practice Address - Street 1:2001 SIESTA DR STE 302
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5200
Practice Address - Country:US
Practice Address - Phone:941-361-6909
Practice Address - Fax:941-361-6914
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL0064200207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology