MEDICARE: DR. EDUARDO JOSE VEJAS CASTILLERO JR. M.D.

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	14064	PR
2	207Q00000X	Family Medicine Physician	577	FL

General Provider Information

NPI Number	:	1568411643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDUARDO JOSE VEJAS CASTILLERO JR. M.D.

Provider Business Mailing Address
First Line	:	7001 INTERBAY BLVD
Second Line	:	APT #308
City	:	TAMPA
State	:	FL
Zip	:	33616-1706
Country	:	US
Telephone Number	:	727-873-3891
Fax Number	:	727-873-3892

Provider Business Practice Location Address
First Line	:	6245 66TH ST N # M
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-5025
Country	:	US
Telephone Number	:	727-873-3891
Fax Number	:	727-873-3892

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	05/14/2021

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