Healthcare Provider Details

I. General information

NPI: 1003511437
Provider Name (Legal Business Name): ALVARO JOSE MEJIA VERGARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-4305
US

IV. Provider business mailing address

6201 W NEWBERRY RD
GAINESVILLE FL
32605-4305
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-8778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME170264
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License NumberME170264
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: