Provider Demographics
NPI:1265460026
Name:VASQUEZ, WINDER NELSON (MD)
Entity Type:Individual
Prefix:
First Name:WINDER
Middle Name:NELSON
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 1:7210 MCPHERSON RD STE 202
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6505
Mailing Address - Country:US
Mailing Address - Phone:956-722-3753
Mailing Address - Fax:956-717-1682
Practice Address - Street 1:7210 MCPHERSON RD STE 202
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6505
Practice Address - Country:US
Practice Address - Phone:956-722-3753
Practice Address - Fax:956-717-1682
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXFG147207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099381802Medicaid
001C46Medicare ID - Type Unspecified
TX099381802Medicaid