Provider Demographics
NPI:1629091301
Name:VASQUEZ, JAIME MOISES (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:MOISES
Last Name:VASQUEZ
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 1:2410 PATTERSON ST STE 401
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-6520
Mailing Address - Country:US
Mailing Address - Phone:615-321-8899
Mailing Address - Fax:615-321-8877
Practice Address - Street 1:2410 PATTERSON ST STE 401
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-6520
Practice Address - Country:US
Practice Address - Phone:615-321-8899
Practice Address - Fax:615-321-8877
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000021256174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB57316Medicare UPIN
TN3058019Medicare ID - Type Unspecified