Provider Demographics
NPI:1114779907
Name:VASQUEZ, GERMAN (PA-S, ARRT (MRI))
Entity Type:Individual
Prefix:
First Name:GERMAN
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:PA-S, ARRT (MRI)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7332 GERRALYN CV
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-1363
Mailing Address - Country:US
Mailing Address - Phone:870-919-7738
Mailing Address - Fax:
Practice Address - Street 1:650 E PARKWAY S
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-5519
Practice Address - Country:US
Practice Address - Phone:870-919-7738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant