Healthcare Provider Details

I. General information

NPI: 1184683922
Provider Name (Legal Business Name): JOSE F. VAZQUEZ DEFILLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15858 SW WARFIELD BLVD
INDIANTOWN FL
34956-0648
US

IV. Provider business mailing address

5827 CORPORATE WAY
WEST PALM BEACH FL
33407-2000
US

V. Phone/Fax

Practice location:
  • Phone: 772-597-3596
  • Fax: 772-597-4194
Mailing address:
  • Phone: 561-844-9443
  • Fax: 561-844-1013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME47728
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: