Provider Demographics
NPI:1467696344
Name:VAZQUEZ, RAY ANTHONY (IDMT)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:ANTHONY
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35TH MEDICAL GROUP
Mailing Address - Street 2:UNIT 5024
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96319-5024
Mailing Address - Country:US
Mailing Address - Phone:01181311-766-1707
Mailing Address - Fax:
Practice Address - Street 1:35TH MEDICAL GROUP
Practice Address - Street 2:UNIT 5024
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96319-5024
Practice Address - Country:US
Practice Address - Phone:01181311-766-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians