Provider Demographics
NPI:1982672713
Name:VELASQUEZ, FERNANDO JOSE (MD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:JOSE
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 1:1523 HIGH KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511
Mailing Address - Country:US
Mailing Address - Phone:813-657-8050
Mailing Address - Fax:813-876-0336
Practice Address - Street 1:2906 W TAMPA BAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1233
Practice Address - Country:US
Practice Address - Phone:813-879-1985
Practice Address - Fax:813-876-0336
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39936208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00293OtherSTAY WELL WELL CARE
FL2054OtherHUMANA HMO
FL53640OtherBLUE CROSS BLUE SHIELD
FL00293OtherSTAY WELL WELL CARE