Provider Demographics
NPI:1144385121
Name:VELAZQUEZ, WILSON LUIS (MD, PA)
Entity type:Individual
Prefix:DR
First Name:WILSON
Middle Name:LUIS
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S STAPLES ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3844
Mailing Address - Country:US
Mailing Address - Phone:361-991-9300
Mailing Address - Fax:361-991-9350
Practice Address - Street 1:5959 S STAPLES ST STE 100
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3844
Practice Address - Country:US
Practice Address - Phone:361-991-9300
Practice Address - Fax:361-991-9350
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8994207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG41279Medicare UPIN