Provider Demographics
NPI:1437387883
Name:VAZQUEZ, LUIS (DO)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 E BEARDSLEY RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-1285
Mailing Address - Country:US
Mailing Address - Phone:602-802-8240
Mailing Address - Fax:602-802-8245
Practice Address - Street 1:2340 E BEARDSLEY RD
Practice Address - Street 2:SUITE 260
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-1285
Practice Address - Country:US
Practice Address - Phone:602-802-8240
Practice Address - Fax:602-802-8245
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018092207YX0905X
AZ006403207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ923114Medicaid