Provider Demographics
NPI:1184683922
Name:VAZQUEZ DEFILLO, JOSE F (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:F
Last Name:VAZQUEZ DEFILLO
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 1:5827 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2000
Mailing Address - Country:US
Mailing Address - Phone:561-844-9443
Mailing Address - Fax:561-844-1013
Practice Address - Street 1:15858 SW WARFIELD BLVD
Practice Address - Street 2:
Practice Address - City:INDIANTOWN
Practice Address - State:FL
Practice Address - Zip Code:34956-0648
Practice Address - Country:US
Practice Address - Phone:772-597-3596
Practice Address - Fax:772-597-4194
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47728208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260509100Medicaid
FL57966OtherBCBS PROVIDER #
FLE76605Medicare UPIN