MEDICARE: DR. JUAN CAMILO CAMACHO-VASQUEZ 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	2085R0202X	Diagnostic Radiology Physician	70246	GA
2	2085B0100X	Body Imaging Physician	70246	GA
3	2085R0202X	Diagnostic Radiology Physician	39782	SC
4	390200000X	Student in an Organized Health Care Education/Training Program	5673	GA
5	2085R0204X	Vascular & Interventional Radiology Physician	ME152815	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1912252404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN CAMILO CAMACHO-VASQUEZ M.D.

Provider Business Mailing Address
First Line	:	1801 S OSPREY AVE UNIT 101
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-3608
Country	:	US
Telephone Number	:	941-552-5500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 S OSPREY AVE UNIT 101
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-3608
Country	:	US
Telephone Number	:	941-552-5500
Fax Number	:	941-552-5501

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

Provider Enumeration Date	:	07/20/2012
Last Update Date	:	12/06/2023

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Directions to “ DR. JUAN CAMILO CAMACHO-VASQUEZ M.D.” Practice Location

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