Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PY3301 | FL |
NPI | 1285164061 |
---|---|
Provider Name | Peter Robert Vagg |
First Address | Tampa, FL 33612-7855 |
Second Address | Tampa, FL 33612-7855 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2017 |
Last Update Date | 14/06/2017 |