Provider Demographics
NPI:1699887943
Name:VAZQUEZ, EDUARDO D (MD)
Entity type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:D
Last Name: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 1:7101 HILLCREEK LN
Mailing Address - Street 2:
Mailing Address - City:GATES MILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44040-9629
Mailing Address - Country:US
Mailing Address - Phone:216-464-9961
Mailing Address - Fax:
Practice Address - Street 1:29133 HEALTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5256
Practice Address - Country:US
Practice Address - Phone:440-835-6212
Practice Address - Fax:440-835-6231
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-04-1016-V2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0308483Medicaid
OH0308483Medicaid
OHVA0440308Medicare ID - Type UnspecifiedMEDICARE NUMBER
OHB95374Medicare UPIN