Provider Demographics
NPI:1639945579
Name:WVAZ MEDICAL SERVICES PLLC
Entity Type:Organization
Organization Name:WVAZ MEDICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WAGNER
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:VAZ GUIMARAES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-929-6874
Mailing Address - Street 1:6537 S STAPLES ST STE125 #348
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRIST
Mailing Address - State:TX
Mailing Address - Zip Code:78413-5423
Mailing Address - Country:US
Mailing Address - Phone:484-929-6874
Mailing Address - Fax:361-371-8373
Practice Address - Street 1:5770 BUCKEYE COURT
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526
Practice Address - Country:US
Practice Address - Phone:484-929-6874
Practice Address - Fax:361-371-8373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty