Provider Demographics
NPI:1902916893
Name:VAZQUEZ-TANUS, JOSE BERNARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:BERNARDO
Last Name:VAZQUEZ-TANUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2225 PONCE BYP
Mailing Address - Street 2:PARRA MEDICAL INSTITUTE SUITE 707
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1321
Mailing Address - Country:US
Mailing Address - Phone:787-259-0526
Mailing Address - Fax:787-259-0546
Practice Address - Street 1:2225 PONCE BYP
Practice Address - Street 2:PARRA MEDICAL INSTITUTE SUITE 707
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1321
Practice Address - Country:US
Practice Address - Phone:787-259-0526
Practice Address - Fax:787-259-0546
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR07913207RC0000X
MI4301071361207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE24341Medicare UPIN
PR008-1635Medicare ID - Type Unspecified