Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | K9692 | TX |
NPI | 1114013307 |
---|---|
Provider Name | Jorge B Velez |
First Address | Pearland, TX 77584-7298 |
Second Address | Houston, TX 77025-1669 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 24/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
045519801 | (05) | TX |
045519804 | (05) | TX |
045519805 | (05) | TX |