Provider Demographics
NPI:1275565053
Name:VAZQUEZ-ALVARADO, LUIS C (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:C
Last Name:VAZQUEZ-ALVARADO
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 1:2466 LAKESHORE CIR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-4118
Mailing Address - Country:US
Mailing Address - Phone:941-624-6240
Mailing Address - Fax:
Practice Address - Street 1:2475 GARRISON AVE
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-5265
Practice Address - Country:US
Practice Address - Phone:850-227-1276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1672083P0901X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG48191Medicare ID - Type Unspecified
FLE7226ZMedicare UPIN