Active NPI
Jonathan B Vasquez, M.D.
- Anatomic Pathology & Clinical Pathology Physician
- Decatur, IL
National Provider Identifier
1093910507
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- Practice address
- 1800 E Lake Shore Dr
Decatur, IL 62521-3810 - Phone
- (217) 464-2966
- NPI assigned
- Jun 15, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | IL | Primary |
Addresses
Primary practice location
1800 E Lake Shore Dr
Decatur, IL 62521-3810
Mailing address
1033 Westmore Meyers Rd
Apt. 110
Lombard, IL 60148-3285
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036111388 | IL | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181865600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093910507",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1033 WESTMORE MEYERS RD",
"address_2": "APT. 110",
"city": "LOMBARD",
"state": "IL",
"postal_code": "601483285"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 E LAKE SHORE DR",
"city": "DECATUR",
"state": "IL",
"postal_code": "625213810",
"telephone_number": "217-464-2966"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VASQUEZ",
"first_name": "JONATHAN",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.