Healthcare Provider Details

I. General information

NPI: 1053381202
Provider Name (Legal Business Name): GARY A VELA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 NW 107TH AVE STE 115
MIAMI FL
33172-3104
US

IV. Provider business mailing address

1080 BRICKELL AVE UNIT 4100
MIAMI FL
33131-3995
US

V. Phone/Fax

Practice location:
  • Phone: 786-607-8979
  • Fax: 305-489-8232
Mailing address:
  • Phone: 437-660-2934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberD 00 63900
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME145984
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: