Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0207X | Pediatric Hematology-Oncologist | 125-051-434 | IL |
Y | 2080P0207X | Pediatric Hematology-Oncologist | MD.205670 | LA |
NPI | 1255592374 |
---|---|
Provider Name | Robert James Vasquez JR. |
First Address | New Orleans, LA 70121-2406 |
Second Address | New Orleans, LA 70121-2429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2008 |
Last Update Date | 11/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2307746 | (05) | LA |