Provider Demographics
NPI:1497824007
Name:VASQUEZ, JULIO CESAR (MD)
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:CESAR
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:777 HOSPITAL WAY STE 215
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5162
Mailing Address - Country:US
Mailing Address - Phone:208-239-2580
Mailing Address - Fax:208-239-2589
Practice Address - Street 1:777 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2753
Practice Address - Country:US
Practice Address - Phone:208-239-2850
Practice Address - Fax:208-239-2589
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM9688208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)