Provider Demographics
NPI:1972574051
Name:VELASQUEZ, ENRIQUE MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:MARTIN
Last Name:VELASQUEZ
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 1:930 FRANKLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4312
Mailing Address - Country:US
Mailing Address - Phone:256-539-4080
Mailing Address - Fax:256-539-4099
Practice Address - Street 1:930 FRANKLIN ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4312
Practice Address - Country:US
Practice Address - Phone:256-539-4080
Practice Address - Fax:256-539-4099
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26544207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL111506Medicaid
ALP00781672OtherRAILROAD MEDICALRE
AL111496Medicaid
AL111504Medicaid
AL111499Medicaid
AL111502Medicaid
25-00726OtherUNITED HEALTHCARE
AL510-49303OtherBCBS
AL51001162OtherBCBS
AL515-99690OtherBCBS
P00233667OtherRAILROAD MEDICARE
AL510-49304OtherBCBS
AL510-49702OtherBCBS
7856614OtherAETNA
AL009992375Medicaid
AL111497Medicaid
AL510-49302OtherBCBS
AL510-49701OtherBCBS
TN4109938OtherBCBS
AL510-49303OtherBCBS
AL510-49701OtherBCBS
P00233667OtherRAILROAD MEDICARE