MEDICARE: MR. ANTONIO A VERA MD

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	208000000X	Pediatrics Physician	6645	PR

General Provider Information

NPI Number	:	1720078819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTONIO A VERA MD

Provider Business Mailing Address
First Line	:	PO BOX 314
Second Line	:
City	:	NARANJITO
State	:	PR
Zip	:	00719-0314
Country	:	US
Telephone Number	:	787-780-8034
Fax Number	:	787-780-8034

Provider Business Practice Location Address
First Line	:	BAYAMON MEDICAL PLZ
Second Line	:	SUITE 805
City	:	BAYAMON
State	:	PR
Zip	:	00959-7200
Country	:	US
Telephone Number	:	787-780-8034
Fax Number	:	787-780-8034

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

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	07/08/2007

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