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General NPI Number Information
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NPI Number | 1699958769
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Entity Type | Organization
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Legal Business Name | VERO BEACH CARDIOVASCULAR ASSOCIATES PA
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 04/27/2012
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Provider Practice Location Address
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Address Line | 1000 36TH ST
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City | VERO BEACH
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State | FL
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Zip | 32960-4862
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Country | US
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Telephone | 772-567-4311
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Fax | 561-357-0869
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Provider Business Mailing Address
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Address Line | PO BOX 864334
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City | ORLANDO
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State | FL
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Zip | 32886-4334
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Country | US
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Telephone | 772-567-4311
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Fax | 561-357-0869
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JAY A MIDWALL
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Credential | M.D.
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Telephone | 772-567-4311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State | FL
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