Healthcare Provider Details

I. General information

NPI: 1407381262
Provider Name (Legal Business Name): PHILIP ANDREW VELEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63110-1016
US

IV. Provider business mailing address

7375 W 52ND AVE STE 210
ARVADA CO
80002-3748
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-7111
  • Fax:
Mailing address:
  • Phone: 915-588-2043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDR.0070718
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberDR.0070718
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: