Provider Demographics
NPI:1255391769
Name:VAZQUEZ, PAUL M (DO)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:13201 WALSINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-3518
Mailing Address - Country:US
Mailing Address - Phone:727-596-9652
Mailing Address - Fax:727-593-5128
Practice Address - Street 1:13201 WALSINGHAM RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3518
Practice Address - Country:US
Practice Address - Phone:727-596-9652
Practice Address - Fax:727-593-5128
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0005236208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047525400Medicaid
FLD60779Medicare UPIN
FL047525400Medicaid