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General NPI Number Information
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NPI Number | 1033119854
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Entity Type | Individual
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Provider Name | LUIS R VEGA M. D.
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Gender | Male
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Dates
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Enumeration Date | 07/22/2005
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Last Update Date | 06/08/2021
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Provider Practice Location Address
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Address Line | 300 MAPLE ST W
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City | HAMPTON
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State | SC
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Zip | 29924-3238
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Country | US
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Telephone | 803-943-3813
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Fax | 803-943-5971
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Provider Business Mailing Address
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Address Line | PO BOX 530062
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City | ATLANTA
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State | GA
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Zip | 30353-0062
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Country | US
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Telephone | 843-695-6071
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Fax | 843-569-5881
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 23033
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 23033
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License Number State | SC
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