Individual
EMILIO J VAZQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4402 E STATE BLVD, FORT WAYNE, IN 46815-6917
(260) 425-5500
(260) 425-5505
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01048856A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000081113
ANTHEM
IL
01
—
000000191942
BC/BS
IN
01
—
080118012
RAILROAD MEDICARE
IN
05
—
200169800
—
IN
01
—
9081
PHYSICIANS HEALTH PLAN
IN
Enumeration date
08/09/2005
Last updated
10/12/2022
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