Provider Demographics
NPI:1871909523
Name:VARGAS, ISAAC (DO)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:
Last Name:VARGAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 WATSON BLVD
Mailing Address - Street 2:ATTN: DECISION SUPPORT/PROVIDER ENROLLMENT
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3431
Mailing Address - Country:US
Mailing Address - Phone:478-922-4281
Mailing Address - Fax:
Practice Address - Street 1:233 N HOUSTON RD STE 140A
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093
Practice Address - Country:US
Practice Address - Phone:478-923-2843
Practice Address - Fax:478-975-6766
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2023-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO3275207Q00000X
GA073867207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003161121AMedicaid