MEDICARE: DR. ERIC VERA MD

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	207V00000X	Obstetrics & Gynecology Physician	052389	GA

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	:	1912971649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC VERA MD

Provider Business Mailing Address
First Line	:	PO BOX 1615
Second Line	:
City	:	VILLA RICA
State	:	GA
Zip	:	30180-6409
Country	:	US
Telephone Number	:	770-771-5235
Fax Number	:	770-771-5236

Provider Business Practice Location Address
First Line	:	403 PERMIAN WAY
Second Line	:	SUITE A
City	:	VILLA RICA
State	:	GA
Zip	:	30180-3252
Country	:	US
Telephone Number	:	770-771-5235
Fax Number	:	770-771-5236

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	02/11/2011

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Directions to “ DR. ERIC VERA MD” Practice Location

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