Provider Demographics
NPI:1912252404
Name:CAMACHO-VASQUEZ, JUAN CAMILO (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CAMILO
Last Name:CAMACHO-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 1:1801 S OSPREY AVE UNIT 101
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3608
Mailing Address - Country:US
Mailing Address - Phone:941-552-5500
Mailing Address - Fax:
Practice Address - Street 1:1801 S OSPREY AVE UNIT 101
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3608
Practice Address - Country:US
Practice Address - Phone:941-552-5500
Practice Address - Fax:941-552-5501
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA702462085R0202X, 2085B0100X
SC397822085R0202X
GA5673390200000X
FLME1528152085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program