Healthcare Provider Details

I. General information

NPI: 1760647705
Provider Name (Legal Business Name): ROBERT L VELARDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5155 BLANTON RD
EUGENE OR
97405-4908
US

IV. Provider business mailing address

5155 BLANTON RD
EUGENE OR
97405-4908
US

V. Phone/Fax

Practice location:
  • Phone: 541-954-9104
  • Fax:
Mailing address:
  • Phone: 541-954-9104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD09583
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: