Provider Demographics
NPI:1114116597
Name:RAMON VAZQUEZ JR MD PA
Entity Type:Organization
Organization Name:RAMON VAZQUEZ JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:561-694-6911
Mailing Address - Street 1:3370 BURNS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4327
Mailing Address - Country:US
Mailing Address - Phone:561-694-6911
Mailing Address - Fax:561-625-3239
Practice Address - Street 1:3370 BURNS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4327
Practice Address - Country:US
Practice Address - Phone:561-694-6911
Practice Address - Fax:561-625-3239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85650208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81495OtherBCBS
FL81495OtherBCBS