Healthcare Provider Details

I. General information

NPI: 1275698201
Provider Name (Legal Business Name): JOHN DANIEL VERGHESE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 OVERSEAS HWY STE 2
MARATHON FL
33050
US

IV. Provider business mailing address

2901 OVERSEAS HWY STE 2
MARATHON FL
33050-2235
US

V. Phone/Fax

Practice location:
  • Phone: 305-289-1975
  • Fax: 305-289-1976
Mailing address:
  • Phone: 305-289-1975
  • Fax: 305-289-1976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME81836
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: