Provider Demographics
NPI:1730251604
Name:VAZQUEZ DEMIGUEL, GASPAR (MD)
Entity type:Individual
Prefix:
First Name:GASPAR
Middle Name:
Last Name:VAZQUEZ DEMIGUEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 ATLANTIC ISLE
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4516
Mailing Address - Country:US
Mailing Address - Phone:305-947-5393
Mailing Address - Fax:
Practice Address - Street 1:3100 S DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6914
Practice Address - Country:US
Practice Address - Phone:305-445-8461
Practice Address - Fax:904-346-0113
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067352207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL930068585OtherRAILROAD MEDICARE
FL26440OtherBCBS
FL377175000Medicaid
P00357012OtherRR MCR
FL930068585OtherRAILROAD MEDICARE
FL377175000Medicaid