Individual
ROBERTO JAFET LOPEZ VEGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1900 TEBEAU ST, WAYCROSS, GA 31501-6357
(201) 417-9656
Mailing address
PO BOX 173, WAYCROSS, GA 31502
(201) 417-9656
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25MA09541600
NJ
208M00000X
Hospitalist Physician
Primary
73605
GA
Other
Enumeration date
07/30/2011
Last updated
07/14/2015
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