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General NPI Number Information
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NPI Number | 1174578710
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Entity Type | Individual
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Provider Name | ROBERT CRUZ VERGARA MD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 03/19/2022
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Provider Practice Location Address
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Address Line | 40100 HIGHWAY 27
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City | DAVENPORT
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State | FL
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Zip | 33837-5900
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Country | US
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Telephone | 863-422-4971
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Fax | 863-419-2264
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Provider Business Mailing Address
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Address Line | 200 CORPORATE BLVD
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City | LAFAYETTE
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State | LA
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Zip | 70508-3870
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Country | US
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Telephone | 800-893-9698
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME95775
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 87392
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME95775
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036115480
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 072944
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License Number State | GA
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Taxonomy #6
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036115480
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License Number State | IL
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