Healthcare Provider Details

I. General information

NPI: 1275565053
Provider Name (Legal Business Name): LUIS C VAZQUEZ-ALVARADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 GARRISON AVE
PORT ST JOE FL
32456-5265
US

IV. Provider business mailing address

2466 LAKESHORE CIR
PORT CHARLOTTE FL
33952-4118
US

V. Phone/Fax

Practice location:
  • Phone: 850-227-1276
  • Fax:
Mailing address:
  • Phone: 941-624-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberACN167
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN167
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: