Provider Demographics
NPI:1942279971
Name:VAZQUEZ, CARLOS J (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:J
Last Name:VAZQUEZ
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 1:700 8TH AVE W
Mailing Address - Street 2:STE 101
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4737
Mailing Address - Country:US
Mailing Address - Phone:941-776-4008
Mailing Address - Fax:941-845-4963
Practice Address - Street 1:12271 US HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-8410
Practice Address - Country:US
Practice Address - Phone:941-776-4050
Practice Address - Fax:941-776-4057
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63251207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371629500Medicaid
FL191900OtherAMERIGROP
FL00451OtherUNIVERSAL MEDICARE MASTERPIECE
FL18354OtherBCBS
FLP102214OtherFREEDOM HEALTH
FL1069024OtherUHC
FL266011OtherWELLCARE
FL266011OtherWELLCARE
FL18354OtherBCBS