Provider Demographics
NPI:1063636629
Name:FRANCO VASQUEZ, GUSTAVO JOSE (MD)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:JOSE
Last Name:FRANCO VASQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25500 POINT LOOKOUT RD FL 2
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2015
Mailing Address - Country:US
Mailing Address - Phone:403-434-4088
Mailing Address - Fax:
Practice Address - Street 1:25500 POINT LOOKOUT RD FL 2
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2015
Practice Address - Country:US
Practice Address - Phone:403-434-4088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD0071844208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery