Healthcare Provider Details

I. General information

NPI: 1952357626
Provider Name (Legal Business Name): RAMON VAZQUEZ JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3370 BURNS RD SUITE 102
PALM BEACH GARDENS FL
33410-4327
US

IV. Provider business mailing address

560 VILLAGE BLVD STE 200
WEST PALM BEACH FL
33409-1963
US

V. Phone/Fax

Practice location:
  • Phone: 561-694-6911
  • Fax: 561-625-3239
Mailing address:
  • Phone: 561-694-6911
  • Fax: 561-625-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME 85650
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME85650
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberME 85650
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberME 85650
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME 85650
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberME 85650
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME 85650
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME 85650
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: