Provider Demographics
NPI:1518915750
Name:VELURY, VIJAYA S (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYA
Middle Name:S
Last Name:VELURY
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 1:3106 NW ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6123
Mailing Address - Country:US
Mailing Address - Phone:580-250-4278
Mailing Address - Fax:580-581-1548
Practice Address - Street 1:3106 NW ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6123
Practice Address - Country:US
Practice Address - Phone:580-250-4278
Practice Address - Fax:580-581-1548
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24897207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200327870Medicaid
OH2188814Medicaid
OK200085440AMedicaid
KY64083298Medicaid
F89080Medicare UPIN
KY64083298Medicaid
OHVE4140111Medicare ID - Type Unspecified