Provider Demographics
NPI:1417031691
Name:VELAT, GREGORY J (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:VELAT
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:PO BOX 864627
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-4627
Mailing Address - Country:US
Mailing Address - Phone:386-231-3540
Mailing Address - Fax:386-231-3544
Practice Address - Street 1:305 MEMORIAL MEDICAL PKWY
Practice Address - Street 2:SUITE 206
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5168
Practice Address - Country:US
Practice Address - Phone:386-231-3540
Practice Address - Fax:386-231-3544
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96815207T00000X
AZ42800207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001170700Medicaid
FLBW972ZMedicare PIN