MEDICARE: DR. RUBEN VASQUEZ JR. 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	208800000X	Urology Physician	93662	SC

General Provider Information

NPI Number	:	1841819059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUBEN VASQUEZ JR. MD

Provider Business Mailing Address
First Line	:	135 PROFESSIONAL PARK DR
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29526-9261
Country	:	US
Telephone Number	:
Fax Number	:	843-716-9772

Provider Business Practice Location Address
First Line	:	135 PROFESSIONAL PARK DR
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29526-9261
Country	:	US
Telephone Number	:	843-347-8765
Fax Number	:

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

Provider Enumeration Date	:	04/09/2020
Last Update Date	:	05/07/2026

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