Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD125904 | FL |
N | 207PE0004X | Emergency Medical Services | 036091114 | IL |
NPI | 1194785691 |
---|---|
Provider Name | Dr. Richard Vasquez |
First Address | Chicago, IL 60694-9000 |
Second Address | Hinsdale, IL 60521-3829 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 27/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036091114 | (05) | IL |
G12583 | (02) | IL |