Individual
JOHNNY J VAZQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1350 S HICKORY STREET, MELBOURNE, FL 32901
(321) 254-6218
(321) 254-6230
Mailing address
PO BOX 361907, MELBOURNE, FL 32906-1907
(321) 254-6218
(321) 254-6230
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
48077
MN
207P00000X
Emergency Medicine Physician
97644
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
277677400
—
FL
01
—
93508
BLUE SHIELD OF FLORIDA
FL
Enumeration date
01/23/2006
Last updated
02/13/2012
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