Provider Demographics
NPI:1760426597
Name:VASQUEZ, EDUARDO JOSE (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:JOSE
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 1:12905 SW 42ND ST STE 213
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2912
Mailing Address - Country:US
Mailing Address - Phone:786-507-8830
Mailing Address - Fax:786-294-6802
Practice Address - Street 1:12905 SW 42ND ST STE 213
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2912
Practice Address - Country:US
Practice Address - Phone:786-507-8830
Practice Address - Fax:786-294-6802
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23545207RP1001X
FL115155207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115155OtherSTATE LICENSE
NE23545OtherSTATE LICENSE