Provider Demographics
NPI:1861440943
Name:VASQUEZ, JAIME JAVIER (DO)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:JAVIER
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 WELBORN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4931
Mailing Address - Country:US
Mailing Address - Phone:214-528-1083
Mailing Address - Fax:214-528-3252
Practice Address - Street 1:2929 WELBORN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4931
Practice Address - Country:US
Practice Address - Phone:214-528-1083
Practice Address - Fax:214-528-3252
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4764207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00G10JMedicare ID - Type Unspecified
TXE23542Medicare UPIN