MEDICARE: DR. RUSSELL SCOTT VEGA 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	207ZF0201X	Forensic Pathology Physician	0064200	FL

General Provider Information

NPI Number	:	1912221425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL SCOTT VEGA M.D.

Provider Business Mailing Address
First Line	:	2001 SIESTA DR STE 302
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-5200
Country	:	US
Telephone Number	:	941-361-6909
Fax Number	:	941-361-6914

Provider Business Practice Location Address
First Line	:	2001 SIESTA DR STE 302
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-5200
Country	:	US
Telephone Number	:	941-361-6909
Fax Number	:	941-361-6914

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

Provider Enumeration Date	:	03/26/2010
Last Update Date	:	03/26/2010

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