Provider Demographics
NPI:1811973480
Name:VELASCO, GRETCHEN M (MD)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:M
Last Name:VELASCO
Suffix:
Gender:F
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:PO BOX 1748
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0030
Mailing Address - Country:US
Mailing Address - Phone:956-581-3900
Mailing Address - Fax:956-581-3904
Practice Address - Street 1:910 S BRYAN RD
Practice Address - Street 2:SUITE 204
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6658
Practice Address - Country:US
Practice Address - Phone:956-581-3900
Practice Address - Fax:956-581-3904
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2725207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMEDICAIDMedicaid
TXMEDICAIDMedicaid
TXH07338Medicare UPIN