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NPI Code Detail

MEDICARE: DR. DONALD HENRY VLIEGENTHART M.D.

MEDICARE: DR. DONALD HENRY VLIEGENTHART M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207X00000XOrthopaedic Surgery PhysicianME36928FL
2207XS0117XOrthopaedic Surgery of the Spine PhysicianME36928FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
126612OTHERFLBCBS OF FL
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003964222
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DONALD HENRY VLIEGENTHART M.D.
Provider Business Mailing Address
First Line : 709 S. HARBOR CITY BOULEVARD
Second Line : SUITE 100
City : MELBOURNE
State : FL
Zip : 32901-1936
Country : US
Telephone Number : 321-725-2225
Fax Number : 321-308-0635
Provider Business Practice Location Address
First Line : 709 S. HARBOR CITY BOULEVARD
Second Line : SUITE 100
City : MELBOURNE
State : FL
Zip : 32901-1936
Country : US
Telephone Number : 321-725-2225
Fax Number : 321-308-0635
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2007
Last Update Date : 06/16/2014

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