Provider Demographics
NPI:1376857268
Name:XIOMARA VELAZCO, M.D. P.A.
Entity Type:Organization
Organization Name:XIOMARA VELAZCO, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:XIOMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-715-9470
Mailing Address - Street 1:4800 NE STALLINGS DR.
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1207
Mailing Address - Country:US
Mailing Address - Phone:936-715-9470
Mailing Address - Fax:936-715-9475
Practice Address - Street 1:4800 NE STALLINGS DR.
Practice Address - Street 2:SUITE 1500
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1207
Practice Address - Country:US
Practice Address - Phone:936-715-9470
Practice Address - Fax:936-715-9475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6749207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty