Provider Demographics
NPI:1326572157
Name:VELEZ FOURNIER, JORGE LUIS (MD, BSME)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:VELEZ FOURNIER
Suffix:
Gender:M
Credentials:MD, BSME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12377 MERIT DR STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-3126
Mailing Address - Country:US
Mailing Address - Phone:972-957-3000
Mailing Address - Fax:
Practice Address - Street 1:3434 W ILLINOIS AVE STE 306-3
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-8709
Practice Address - Country:US
Practice Address - Phone:214-623-1900
Practice Address - Fax:214-623-1901
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-01722208000000X, 2084N0402X
TXT7073208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics