MEDICARE: FERNANDO J VELASQUEZ MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME39936	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	77331	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1043382070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FERNANDO J VELASQUEZ MD PA

Provider Business Mailing Address
First Line	:	2906 WEST TAMPA BAY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-1233
Country	:	US
Telephone Number	:	813-879-1985
Fax Number	:	813-876-0336

Provider Business Practice Location Address
First Line	:	2906 WEST TAMPA BAY BOULEVARD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-1233
Country	:	US
Telephone Number	:	813-879-1985
Fax Number	:	813-876-0336

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	FERNANDO JOSE VELASQUEZ
Credential	:	MD
Telephone Number	:	813-879-1985

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	08/22/2020

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