Provider Demographics
NPI:1215106216
Name:STUART VAZQUEZ, BRAYAN (MD)
Entity type:Individual
Prefix:DR
First Name:BRAYAN
Middle Name:
Last Name:STUART VAZQUEZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:BRAYAN
Other - Middle Name:
Other - Last Name:STUART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:777 LOWNDES HILL RD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2101
Mailing Address - Country:US
Mailing Address - Phone:864-908-3583
Mailing Address - Fax:855-818-4732
Practice Address - Street 1:6200 SW 73RD ST
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4679
Practice Address - Country:US
Practice Address - Phone:786-662-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276910207V00000X
PR18008207V00000X
FLME124222207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL124122800Medicaid