Provider Demographics
NPI:1750324166
Name:VASQUEZ, JAVIER JR (MD)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:VASQUEZ
Suffix:JR
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 1:621 N HALL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226-1305
Mailing Address - Country:US
Mailing Address - Phone:148-219-6002
Mailing Address - Fax:214-823-5290
Practice Address - Street 1:621 N HALL ST STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1305
Practice Address - Country:US
Practice Address - Phone:214-821-9600
Practice Address - Fax:214-823-5290
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8992174400000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167640501Medicaid
TXI08460Medicare UPIN
TX8B9277Medicare ID - Type Unspecified