MEDICARE: DR. WILFREDO VEGA PAGAN 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
1	208D00000X	General Practice Physician	017638	PR

General Provider Information

NPI Number	:	1063642502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILFREDO VEGA PAGAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2780
Second Line	:
City	:	SAN GERMAN
State	:	PR
Zip	:	00683-2780
Country	:	US
Telephone Number	:	787-458-2509
Fax Number	:

Provider Business Practice Location Address
First Line	:	#2250 CALLE DR. CARLOS LUGO
Second Line	:
City	:	SAN ANTONIO
State	:	PR
Zip	:	00690
Country	:	US
Telephone Number	:	787-458-2509
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2009
Last Update Date	:	06/15/2016

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