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General NPI Number Information
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NPI Number | 1659477677
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Entity Type | Individual
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Provider Name | ANGEL VAZQUEZ MD
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Gender | Male
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 01/23/2014
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Provider Practice Location Address
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Address Line | 603 S CANAL ST
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City | WHITEVILLE
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State | NC
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Zip | 28472-4256
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Country | US
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Telephone | 910-642-3700
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Fax | 910-642-5146
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Provider Business Mailing Address
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Address Line | 603 S CANAL ST
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City | WHITEVILLE
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State | NC
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Zip | 28472-4256
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Country | US
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Telephone | 910-642-3700
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Fax | 910-642-5146
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 9701181
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License Number State | NC
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