Provider Demographics
NPI:1467449215
Name:VELARDE, DONALD JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JOSEPH
Last Name:VELARDE
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 1:4711 E FALCON DR
Mailing Address - Street 2:SUITE 355
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-2508
Mailing Address - Country:US
Mailing Address - Phone:480-357-2048
Mailing Address - Fax:480-214-5147
Practice Address - Street 1:4711 E FALCON DR
Practice Address - Street 2:SUITE 355
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-2508
Practice Address - Country:US
Practice Address - Phone:480-357-2048
Practice Address - Fax:480-214-5147
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22015208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ392689OtherAHCCCS
72482Medicare ID - Type Unspecified
F73111Medicare UPIN