| Doctor Name: | DR. LUIS J VAZQUEZ |
| NPI Number: | 1871634238 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | ME0021040 |
| Business Practice Address: | 2120 Marshall Edwards Dr Bartow, FL - 338306731 |
| Business Phone Number: | 8635197579 |
| Business Fax Number: | 8635194783 |
| Mailing Address: | 6664 Chadron Ct, LAKELAND |
| State: | FL |
| Postal Code: | 338133711 |
| Phone Number: | 8636489609 |
| Fax Number: | 8636463945 |
| NPI Enumeration Date: | 02/09/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME0021040 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |