MEDICARE: DONNA I VASQUEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036115387	IL
2	207Q00000X	Family Medicine Physician	P8321	TX

General Provider Information

NPI Number	:	1154333169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA I VASQUEZ MD

Provider Business Mailing Address
First Line	:	12221 MERIT DR STE 1500
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-2235
Country	:	US
Telephone Number	:	214-217-1911
Fax Number	:

Provider Business Practice Location Address
First Line	:	3591 MCKINNEY ST
Second Line	:	SUITE 100
City	:	MELISSA
State	:	TX
Zip	:	75454-9571
Country	:	US
Telephone Number	:	972-837-1075
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	12/29/2014

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