Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1761 | ME |
N | 207Q00000X | Family Doctor | 1761 | ME |
NPI | 1043241516 |
---|---|
Provider Name | Miguel A. Velazquez |
First Address | Westbrook, ME 04092-4817 |
Second Address | Westbrook, ME 04092-4817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 04/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
431815799 | (05) | ME |
I35213 | (02) | ME |