Individual
DR. RAUL STEPHEN DE LA VEGA III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
222 N LAFAYETTE ST, SUITE 01, SHELBY, NC 28150-4444
(704) 482-3880
(704) 487-0294
Mailing address
222 N LAFAYETTE ST, SUITE 01, SHELBY, NC 28150-4444
(704) 482-3880
(704) 487-0294
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
24584
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24584
NC MEDICAL LICENSE
NC
01
—
28077
NC BLUE CROSS BLUE SHIELD
NC
05
—
8928077
—
NC
05
—
N24584
—
SC
Enumeration date
01/13/2006
Last updated
03/07/2023
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