Basic Information
| Provider Information | |||||||||
| NPI: | 1588730113 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARQUES | ||||||||
| FirstName: | VASCO | ||||||||
| MiddleName: | MIGUEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3010 E 138TH AVE | ||||||||
| Address2: | SUITE 12 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336133904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139752800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3010 E 138TH AVE | ||||||||
| Address2: | SUITE #12 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336133904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139752800 | ||||||||
| FaxNumber: | 8139777631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2006 | ||||||||
| LastUpdateDate: | 03/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | ME80196 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | ME80196 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 258957500 | 05 | FL | MEDICAID |