Individual
ERNESTO VAZQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1601 NW 114TH ST, CLIVE, IA 50325-7007
(515) 222-7000
(515) 222-7037
Mailing address
PO BOX 1475, DES MOINES, IA 50305-1475
(515) 222-7000
(515) 222-7037
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD.40789
AL
207Q00000X
Family Medicine Physician
Primary
MD-34198
IA
207Q00000X
Family Medicine Physician
MD37608
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
388261
—
TN
Enumeration date
11/14/2005
Last updated
06/23/2020
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