Provider Demographics
NPI:1023257177
Name:VELOSO, JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:VELOSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOEY
Other - Middle Name:
Other - Last Name:VELOSO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:930 MISTLETOE DR
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:TX
Mailing Address - Zip Code:76226-6980
Mailing Address - Country:US
Mailing Address - Phone:815-382-4520
Mailing Address - Fax:
Practice Address - Street 1:6300 LA CALMA DR
Practice Address - Street 2:SUITE 200 C/O ESP
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3843
Practice Address - Country:US
Practice Address - Phone:815-382-4520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125054497207P00000X
TXP1942207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine