MEDICARE: DR. JOSE LUIS VEGA III 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	207Q00000X	Family Medicine Physician	54496	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881955169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE LUIS VEGA III M.D.

Provider Business Mailing Address
First Line	:	2060 W 24TH ST
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-6123
Country	:	US
Telephone Number	:	928-819-8834
Fax Number	:	928-539-5579

Provider Business Practice Location Address
First Line	:	675 S AVENUE B
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-2749
Country	:	US
Telephone Number	:	928-539-3140
Fax Number	:	928-782-5296

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

Provider Enumeration Date	:	06/04/2012
Last Update Date	:	02/14/2019

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