Healthcare Provider Details

I. General information

NPI: 1497254593
Provider Name (Legal Business Name): RAUL VAZQUEZ-REYES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 NW 67TH AVE STE 306
MIAMI LAKES FL
33014-2176
US

IV. Provider business mailing address

5101 SW 8TH ST STE 200
CORAL GABLES FL
33134-2442
US

V. Phone/Fax

Practice location:
  • Phone: 305-709-0105
  • Fax: 305-709-0106
Mailing address:
  • Phone: 305-359-5037
  • Fax: 786-509-5544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME179073
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: