Provider Demographics
NPI:1083647952
Name:VAZQUEZ, JOSE L (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:L
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1691 MICHIGAN AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-2520
Mailing Address - Country:US
Mailing Address - Phone:786-595-8220
Mailing Address - Fax:786-433-9466
Practice Address - Street 1:1691 MICHIGAN AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-2520
Practice Address - Country:US
Practice Address - Phone:786-595-8220
Practice Address - Fax:786-433-9466
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME65495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252010900Medicaid
FL32932XMedicare PIN
FL252010900Medicaid