=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831113208
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VERO GASTROENTEROLOGY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 10/03/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3745 11TH CIR SUITE 101
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-4837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-299-3511
-----------------------------------------------------
Fax | 772-299-3517
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3745 11TH CIR SUITE 101
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-4837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-299-3511
-----------------------------------------------------
Fax | 772-299-3517
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JOSEPH JOHN ZEREGA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 772-299-3511
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------