Individual
JOSE A. VAZQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1120 15TH STREET, AUGUSTA, GA 30912-0004
(706) 724-6100
Mailing address
1499 WALTON WAY, AUGUSTA, GA 30901-2603
(706) 724-6100
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301053567
MI
207RI0200X
Infectious Disease Physician
Primary
4301053567
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003141369A
—
GA
01
—
440Q263940
BLUE CROSS-BLUE CROSS
—
05
—
450327810
—
MI
01
—
52609049 001
BCBS OF GEORGIA
GA
01
—
JV053567
CHAMPUS-CHAMPUS
—
Enumeration date
12/01/2006
Last updated
02/24/2015
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