=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114116597
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAMON VAZQUEZ JR MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2007
-----------------------------------------------------
Last Update Date | 11/30/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3370 BURNS RD SUITE 102
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33410-4327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-694-6911
-----------------------------------------------------
Fax | 561-625-3239
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3370 BURNS RD SUITE 102
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33410-4327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-694-6911
-----------------------------------------------------
Fax | 561-625-3239
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RAMON VAZQUEZ JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 561-694-6911
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | ME85650
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------