MEDICARE: MARIO CERVANTES-VAZQUEZ M.D.

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	207ZH0000X	Hematology (Pathology) Physician	H7953	TX
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	H7953	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	220033031	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245234616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIO CERVANTES-VAZQUEZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 746559
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6559
Country	:	US
Telephone Number	:	281-348-8279
Fax Number	:	281-348-8275

Provider Business Practice Location Address
First Line	:	22999 HIGHWAY 59 N
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-4412
Country	:	US
Telephone Number	:	281-348-8279
Fax Number	:	281-348-8275

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	10/25/2022

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Directions to “ MARIO CERVANTES-VAZQUEZ M.D.” Practice Location

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