MEDICARE: DR. JORGE L. VAZQUEZ 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	ME107365	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	:	1992990212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE L. VAZQUEZ MD

Provider Business Mailing Address
First Line	:	1140 S SEMORAN BLVD
Second Line	:	SUITE E
City	:	ORLANDO
State	:	FL
Zip	:	32807-1459
Country	:	US
Telephone Number	:	407-384-9165
Fax Number	:	407-384-9174

Provider Business Practice Location Address
First Line	:	1140 S SEMORAN BLVD
Second Line	:	SUITE E
City	:	ORLANDO
State	:	FL
Zip	:	32807-1459
Country	:	US
Telephone Number	:	407-384-9165
Fax Number	:	407-384-9174

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

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	03/07/2023

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