Provider Demographics
NPI:1831286830
Name:VELA, STACIE ANN FRIESEN (MD)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:ANN FRIESEN
Last Name:VELA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:ANN
Other - Last Name:FRIESEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:650 E INDIAN SCHOOL RD
Mailing Address - Street 2:6TH FLOOR GI LAB
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1839
Mailing Address - Country:US
Mailing Address - Phone:602-277-5551
Mailing Address - Fax:602-222-6562
Practice Address - Street 1:650 E INDIAN SCHOOL RD
Practice Address - Street 2:6TH FLOOR GI LAB
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1839
Practice Address - Country:US
Practice Address - Phone:602-277-5551
Practice Address - Fax:602-222-6562
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL27100207RG0100X
TXN5456207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L26477Medicare PIN
TX8L25436Medicare PIN