Provider Demographics
NPI:1154333169
Name:VASQUEZ, DONNA I (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:I
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 MERIT DR STE 1500
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2235
Mailing Address - Country:US
Mailing Address - Phone:214-217-1911
Mailing Address - Fax:
Practice Address - Street 1:3591 MCKINNEY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-9571
Practice Address - Country:US
Practice Address - Phone:972-837-1075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115387207Q00000X
TXP8321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX349063YXB5Medicare PIN
TX349063YMZXMedicare PIN