Provider Demographics
NPI:1619175635
Name:VELEZ, ALFREDO J (MD)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:J
Last Name:VELEZ
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 1:1140 WILLAGILLESPIE RD STE 44
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6727
Mailing Address - Country:US
Mailing Address - Phone:480-209-9074
Mailing Address - Fax:458-201-3834
Practice Address - Street 1:150 S WALL ST
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-3233
Practice Address - Country:US
Practice Address - Phone:541-435-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD288312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500601188Medicaid
OR500601188Medicaid