Provider Demographics
NPI:1588899348
Name:PEREZ VAZQUEZ, RAUL ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:ANTONIO
Last Name:PEREZ VAZQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 MANSFIELD J
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4940
Mailing Address - Country:US
Mailing Address - Phone:248-886-9168
Mailing Address - Fax:
Practice Address - Street 1:2820 NE 214TH ST STE 801
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1269
Practice Address - Country:US
Practice Address - Phone:888-803-3370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116463207R00000X
NY32042901207R00000X
MI4301094878207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine