Provider Demographics
NPI:1801830997
Name:VAZQUEZ, JEFFEREY RUY (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFEREY
Middle Name:RUY
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 370375
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79937-0375
Mailing Address - Country:US
Mailing Address - Phone:915-592-4173
Mailing Address - Fax:915-592-4174
Practice Address - Street 1:10470 VISTA DEL SOL DR
Practice Address - Street 2:SUITE 211
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7948
Practice Address - Country:US
Practice Address - Phone:915-592-4173
Practice Address - Fax:915-592-4174
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1629213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166444301Medicaid
TXU99713Medicare UPIN
TX166444301Medicaid