Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | DS9751 | TN |
Y | 204E00000X | Oral & Maxillofacial Surgeon | DS9751 | TN |
NPI | 1407875958 |
---|---|
Provider Name | Dr. Luis Guillermo Vega |
First Address | Nashville, TN 37232-0001 |
Second Address | Nashville, TN 37232-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 15/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0762091-00 | (05) | FL |
807814146A | (05) | GA |
P00323221 | RAILROAD MEDICARE (01) | FL |
V09865 | (02) | FL |