Provider Demographics
NPI:1487323499
Name:VASQUEZ, WILLIE RAYMOND JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:RAYMOND
Last Name:VASQUEZ
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:WILL
Other - Middle Name:RAYMOND
Other - Last Name:VASQUEZ
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1235 HEYMAN LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2909
Mailing Address - Country:US
Mailing Address - Phone:318-308-3834
Mailing Address - Fax:
Practice Address - Street 1:2389 HIGHWAY 28 E
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-5607
Practice Address - Country:US
Practice Address - Phone:318-487-1925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.A10563363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical