Provider Demographics
NPI:1134396724
Name:VAZQUEZ, MERCEDES J (MD PA)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:J
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N KROME AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4455
Mailing Address - Country:US
Mailing Address - Phone:305-242-0911
Mailing Address - Fax:305-242-0912
Practice Address - Street 1:950 N KROME AVE STE 203
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4455
Practice Address - Country:US
Practice Address - Phone:305-242-0911
Practice Address - Fax:305-242-0912
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0105610207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001669600Medicaid
FL001669601Medicaid