Provider Demographics
NPI:1083613731
Name:VELAZQUEZ, HIRAM DEXTER (MD)
Entity Type:Individual
Prefix:DR
First Name:HIRAM
Middle Name:DEXTER
Last Name:VELAZQUEZ
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 1:944 CALLE ARBOLEDA
Mailing Address - Street 2:VALLE VERDE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-3513
Mailing Address - Country:US
Mailing Address - Phone:787-842-0093
Mailing Address - Fax:
Practice Address - Street 1:944 CALLE ARBOLEDA
Practice Address - Street 2:VALLE VERDE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-3513
Practice Address - Country:US
Practice Address - Phone:787-842-0093
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10326208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
8-3626Medicare UPIN