Provider Demographics
NPI:1942351861
Name:VELASCO, ANDRES F (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:F
Last Name:VELASCO
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 1:1565 SAXON BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725
Mailing Address - Country:US
Mailing Address - Phone:386-574-1423
Mailing Address - Fax:321-684-5212
Practice Address - Street 1:1565 SAXON BLVD STE 103
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725
Practice Address - Country:US
Practice Address - Phone:386-574-1423
Practice Address - Fax:321-684-5212
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96936174400000X, 207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI49036Medicare UPIN
FL6386320004Medicare NSC
FL6386320003Medicare NSC
FL6386320005Medicare NSC
NMNM301519Medicare PIN