Provider Demographics
NPI:1740581180
Name:VELAZQUEZ STUART, JUAN LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:LUIS
Last Name:VELAZQUEZ STUART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3181 CORAL WAY
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145
Mailing Address - Country:US
Mailing Address - Phone:305-856-1002
Mailing Address - Fax:877-809-8253
Practice Address - Street 1:3181 CORAL WAY
Practice Address - Street 2:4TH FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145
Practice Address - Country:US
Practice Address - Phone:305-856-1002
Practice Address - Fax:877-809-8253
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1361132086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100628600Medicaid
PR12746-IOtherMEDICAL STATE LICENSE #