Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 038-006768 | IL |
N | 111NN0400X | Neurology | A05679 | IA |
NPI | 1356480222 |
---|---|
Provider Name | Dr. Daniel Vazquez |
First Address | Moline, IL 61265-6038 |
Second Address | Moline, IL 61265-6038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 13/10/2011 |