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Individual

LUIS O VASCONEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
619 19TH STREET SOUTH, BIRMINGHAM, AL 35233
(205) 934-4011
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701

Taxonomy

Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
12399
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000014647
BLUE CROSS
AL
05
000014647
AL
05
009932092
AL
01
051529687
BLUE CROSS
AL
01
A47233
VIVA
AL
Enumeration date
07/24/2006
Last updated
05/28/2011
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