Provider Demographics
NPI:1568520906
Name:VAZQUEZ-VICENTE, JOSE ORLANDO (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ORLANDO
Last Name:VAZQUEZ-VICENTE
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 1:1301 N RACE ST
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-3483
Mailing Address - Country:US
Mailing Address - Phone:270-651-4444
Mailing Address - Fax:
Practice Address - Street 1:310 N L ROGERS WELLS BLVD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1300
Practice Address - Country:US
Practice Address - Phone:270-659-5865
Practice Address - Fax:270-659-5854
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3413207V00000X
KY04874207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY04874OtherKY LICENSE