Provider Demographics
NPI:1407043904
Name:VELA, RUDOLPH JESSE (MD)
Entity Type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:JESSE
Last Name:VELA
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 1:7595 COUNTY ROAD 236
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-8738
Mailing Address - Country:US
Mailing Address - Phone:419-427-1984
Mailing Address - Fax:419-427-2524
Practice Address - Street 1:3101 W. U.S. RTE 224
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-8305
Practice Address - Country:US
Practice Address - Phone:419-448-0220
Practice Address - Fax:419-448-3850
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VE0597662OtherMEDICARE
OH0659498Medicaid
A16865Medicare UPIN