Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 18000 | TX |
N | 213EG0000X | General Practice | 18000 | TX |
N | 1223P0300X | Periodontist | 18000 | TX |
NPI | 1093803645 |
---|---|
Provider Name | Dr. Jesus Mario Velasquez |
First Address | Houston, TX 77063-3947 |
Second Address | Houston, TX 77063-3947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 09/07/2007 |