Healthcare Provider Details

I. General information

NPI: 1114185154
Provider Name (Legal Business Name): MARCELO PAUL VARGAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MAYO CLINIC
ROCHESTER MN
55905-0001
US

IV. Provider business mailing address

2525 CHICAGO AVE. CHILDREN'S HOSPITALS AND CLINICS OF MINNESOTA
MINNEAPOLIS MN
55404
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number57930
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: