Healthcare Provider Details

I. General information

NPI: 1235424466
Provider Name (Legal Business Name): JOSEPH MILES VELLA D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 SW RAMSEY AVE
GRANTS PASS OR
97527-5681
US

IV. Provider business mailing address

495 SW RAMSEY AVE # 124
GRANTS PASS OR
97527-5681
US

V. Phone/Fax

Practice location:
  • Phone: 541-476-6644
  • Fax:
Mailing address:
  • Phone: 541-476-6644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberL2034661
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: