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General NPI Number Information
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NPI Number | 1134104078
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Entity Type | Individual
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Provider Name | GERMAN VERGARA MD
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Gender | Male
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 12/04/2012
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Provider Practice Location Address
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Address Line | 1295 SOUTH US HIGWAY 1
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City | ROCKLEDGE
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State | FL
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Zip | 32955
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Country | US
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Telephone | 321-637-6654
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Fax | 321-433-1119
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Provider Business Mailing Address
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Address Line | 1295 S US HIGHWAY 1
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City | ROCKLEDGE
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State | FL
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Zip | 32955
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Country | US
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Telephone | 321-637-6654
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Fax | 321-433-1119
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | ME0067503
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License Number State | FL
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