Provider Demographics
NPI:1811949258
Name:VASQUEZ, JON J (MD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:J
Last Name:VASQUEZ
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:PO BOX 2710
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-2710
Mailing Address - Country:US
Mailing Address - Phone:480-882-6359
Mailing Address - Fax:480-882-4389
Practice Address - Street 1:70 S VAL VISTA DR STE A3-621
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1374
Practice Address - Country:US
Practice Address - Phone:480-347-4648
Practice Address - Fax:833-336-6898
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30428207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ70832Medicare PIN
AZH74360Medicare UPIN