Provider Demographics
NPI:1891783080
Name:BAYRON VELEZ, FERNANDO E (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:E
Last Name:BAYRON 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 1:4900 W OAKLAND PARK BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1555
Mailing Address - Country:US
Mailing Address - Phone:954-472-1322
Mailing Address - Fax:954-370-3420
Practice Address - Street 1:4900 W OAKLAND PARK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1555
Practice Address - Country:US
Practice Address - Phone:954-472-1322
Practice Address - Fax:954-370-3420
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 93401208600000X
PR11131208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274362100Medicaid
FL37101AMedicare PIN
PRF-56904Medicare UPIN
PR83327Medicare ID - Type Unspecified