MEDICARE: JOHAN VARGAS 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	14244-I	PR
2	207Q00000X	Family Medicine Physician	ACN1623	FL

General Provider Information

NPI Number	:	1578002903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHAN VARGAS M.D.

Provider Business Mailing Address
First Line	:	404 AVENIDA GENERAL VALERO
Second Line	:
City	:	FAJARDO
State	:	PR
Zip	:	00738
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1421 BARTOW RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-6574
Country	:	US
Telephone Number	:	813-499-1500
Fax Number	:	813-213-0440

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

Provider Enumeration Date	:	02/17/2017
Last Update Date	:	03/17/2025

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