Individual
MR. CARLOS D AMY VAZQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1213 STATE ROAD 20, INTERLACHEN, FL 32148-2737
(386) 684-4914
(386) 684-6524
Mailing address
1302 RIVER ST, PALATKA, FL 32177-5042
(386) 328-0108
(386) 325-1086
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
15813
PR
208D00000X
General Practice Physician
Primary
ACN1030
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15813
MEDICAL LICENSE
PR
01
—
ACN1030
FLORIDA MEDICAL LICENSE
FL
Enumeration date
05/24/2006
Last updated
03/22/2022
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