Provider Demographics
NPI:1366971244
Name:VASQUEZ DURAN, RAUL EMILIO (MD)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:EMILIO
Last Name:VASQUEZ DURAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 E JERSEY ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-5503
Mailing Address - Country:US
Mailing Address - Phone:908-440-6395
Mailing Address - Fax:908-440-6396
Practice Address - Street 1:1019 E JERSEY ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-5503
Practice Address - Country:US
Practice Address - Phone:908-440-6395
Practice Address - Fax:908-440-6396
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10746400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine