MEDICARE: PETER 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	208D00000X	General Practice Physician	29561	AZ

General Provider Information

NPI Number	:	1679794135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER VASQUEZ MD

Provider Business Mailing Address
First Line	:	53393 W CANDLELIGHT RD
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85239-6309
Country	:	US
Telephone Number	:	216-288-9650
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 S DOBSON RD
Second Line	:	INTEL HEALTH FOR LIFE CENTER M/S:OC2-117
City	:	CHANDLER
State	:	AZ
Zip	:	85248-4907
Country	:	US
Telephone Number	:	216-288-9650
Fax Number	:

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	12/15/2008

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