Provider Demographics
NPI:1669441739
Name:VASQUEZ, DONALD G (DO)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:G
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 47490
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-7490
Mailing Address - Country:US
Mailing Address - Phone:316-962-3150
Mailing Address - Fax:316-962-7334
Practice Address - Street 1:550 N HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4910
Practice Address - Country:US
Practice Address - Phone:316-962-3150
Practice Address - Fax:316-962-7334
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-300382086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS521880OtherFIRSTGUARD
KS203441OtherHEALTH PARTNERS OF KANSAS
KS103127OtherBLUE CROSS BLUE SHIELD
KS203441OtherHEALTH PARTNERS OF KANSAS
KSG00640Medicare UPIN
KSDB6539Medicare ID - Type UnspecifiedRAILROAD MEDICARE