MEDICARE: MD VIERA HEALTHCARE, PA

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	207Q00000X	Family Medicine Physician	ME85264	FL

General Provider Information

NPI Number	:	1730551664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MD VIERA HEALTHCARE, PA

Provider Business Mailing Address
First Line	:	7000 SPYGLASS COURT
Second Line	:	STE 130
City	:	MELBOURNE
State	:	FL
Zip	:	32940
Country	:	US
Telephone Number	:	321-544-5298
Fax Number	:	888-370-3210

Provider Business Practice Location Address
First Line	:	7000 SPYGLASS CT
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-8288
Country	:	US
Telephone Number	:	321-544-5298
Fax Number	:	888-370-3210

Authorized Official
Title or Position	:	AGENT
Name	:	LOQUITA ALLAIRE
Credential	:
Telephone Number	:	321-544-5298

Provider Enumeration Date	:	10/30/2015
Last Update Date	:	11/20/2015

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