Healthcare Provider Details

I. General information

NPI: 1184667198
Provider Name (Legal Business Name): JOSE EMILIO VASQUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 MORRISON RD SUITE 104
BRANDON FL
33511-4849
US

IV. Provider business mailing address

214 MORRISON RD SUITE 104
BRANDON FL
33511-4849
US

V. Phone/Fax

Practice location:
  • Phone: 813-681-6474
  • Fax: 813-654-8473
Mailing address:
  • Phone: 813-681-6474
  • Fax: 813-654-8473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME77683
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: