Provider Demographics
NPI:1104908581
Name:VASQUEZ, DEBRA A (MD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N SAINT MARYS ST STE 1400
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-3535
Mailing Address - Country:US
Mailing Address - Phone:210-325-1222
Mailing Address - Fax:
Practice Address - Street 1:111 DALLAS ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1201
Practice Address - Country:US
Practice Address - Phone:210-325-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2169207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8P1781OtherBLUE CROSS & BLUE SHIELD
TX177025701Medicaid
TXP00271875OtherRAIL ROAD MEDICARE
TX8P1781OtherBLUE CROSS & BLUE SHIELD
TXI45603Medicare UPIN