Provider Demographics
NPI:1114090024
Name:PEREZ VAZQUEZ, JUAN ANTONIO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:ANTONIO
Last Name:PEREZ VAZQUEZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4644
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-4644
Mailing Address - Country:US
Mailing Address - Phone:787-858-6208
Mailing Address - Fax:787-858-6208
Practice Address - Street 1:46 JJ ACOSTA
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-858-6208
Practice Address - Fax:787-858-6208
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR6765208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
C79745Medicare UPIN
28416Medicare ID - Type Unspecified