Healthcare Provider Details

I. General information

NPI: 1194384297
Provider Name (Legal Business Name): JORGE A. VEGA JR., M.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E COMMERCIAL BLVD STE 102
FORT LAUDERDALE FL
33308-4202
US

IV. Provider business mailing address

2800 E COMMERCIAL BLVD STE 102
FORT LAUDERDALE FL
33308-4202
US

V. Phone/Fax

Practice location:
  • Phone: 954-491-0900
  • Fax:
Mailing address:
  • Phone: 561-440-3740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JORGE ALBERTO VEGA JR.
Title or Position: AUTHORIZED MEMBER
Credential: MD
Phone: 561-440-3740