Provider Demographics
NPI:1972578847
Name:VAZQUEZ, INES EUNICE (MD)
Entity Type:Individual
Prefix:DR
First Name:INES
Middle Name:EUNICE
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:INES
Other - Middle Name:EUNICE
Other - Last Name:CONCEPCION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:7322 SOUTHWEST FWY
Practice Address - Street 2:SUITE 160
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2010
Practice Address - Country:US
Practice Address - Phone:713-532-6884
Practice Address - Fax:713-532-5756
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1420207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088333201Medicaid
TX125486405Medicaid
TX7420891032OtherTAX ID NUMBER
TX092952301Medicaid
TX8R9150OtherBLUE CROSS BLUE SHIELD
TX7420891032OtherTAX ID NUMBER
TX00HE59Medicare ID - Type Unspecified
TX092952301Medicaid
TX125486405Medicaid