Provider Demographics
NPI:1184667198
Name:VASQUEZ, JOSE EMILIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:EMILIO
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 MORRISON RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4849
Mailing Address - Country:US
Mailing Address - Phone:813-681-6474
Mailing Address - Fax:813-654-8473
Practice Address - Street 1:214 MORRISON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4849
Practice Address - Country:US
Practice Address - Phone:813-681-6474
Practice Address - Fax:813-654-8473
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77683207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258889700Medicaid
FL258889700Medicaid
FL46318ZMedicare ID - Type UnspecifiedMEDICARE