Provider Demographics
NPI:1679794135
Name:VASQUEZ, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
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 1:53393 W CANDLELIGHT RD
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85239-6309
Mailing Address - Country:US
Mailing Address - Phone:216-288-9650
Mailing Address - Fax:
Practice Address - Street 1:4500 S DOBSON RD
Practice Address - Street 2:INTEL HEALTH FOR LIFE CENTER M/S:OC2-117
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-4907
Practice Address - Country:US
Practice Address - Phone:216-288-9650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29561208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice