MEDICARE: LAURA DEMOYA VEGA MD PA

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	207R00000X	Internal Medicine Physician	M4028	TX

General Provider Information

NPI Number	:	1437554409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURA DEMOYA VEGA MD PA

Provider Business Mailing Address
First Line	:	P O POX 140767
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-0767
Country	:	US
Telephone Number	:	469-939-5330
Fax Number	:

Provider Business Practice Location Address
First Line	:	6629 SONDRA DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-3404
Country	:	US
Telephone Number	:	469-939-5330
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	LAURA DEMOYA VEGA
Credential	:	MD
Telephone Number	:	469-939-5330

Provider Enumeration Date	:	11/03/2014
Last Update Date	:	11/03/2014

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