MEDICARE: RODERICK V. VERGEL DE DIOS, M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	K1713	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080152499	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	5805616	OTHER		AETNA
3	0021DF	OTHER	TX	BLUE CROSS BLUE SHIELD
4	116761	OTHER		SUPERIOR HEALTH PLAN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	A001	OTHER		CHAMPUS
7	A002	OTHER		TRICARE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083879019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RODERICK V. VERGEL DE DIOS, M.D., P.A.

Provider Business Mailing Address
First Line	:	5105 N MCCOLL RD
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-2331
Country	:	US
Telephone Number	:	956-686-6644
Fax Number	:	956-686-6643

Provider Business Practice Location Address
First Line	:	5105 N MCCOLL RD
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-2331
Country	:	US
Telephone Number	:	956-686-6644
Fax Number	:	956-686-6643

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. RODERICK VILLAROMAN VERGEL DE DIOS
Credential	:	M.D.
Telephone Number	:	956-686-6644

Provider Enumeration Date	:	07/18/2008
Last Update Date	:	10/26/2010

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