Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 006403 | AZ |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 5101018092 | MI |
NPI | 1437387883 |
---|---|
Provider Name | Dr. Luis Vazquez |
First Address | Phoenix, AZ 85024-1285 |
Second Address | Phoenix, AZ 85024-1285 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2009 |
Last Update Date | 12/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
923114 | (05) | AZ |