Healthcare Provider Details

I. General information

NPI: 1003874801
Provider Name (Legal Business Name): PEDRO VELASQUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 CRESTHAVEN RD STE 300
MEMPHIS TN
38119-0809
US

IV. Provider business mailing address

6074 APPLE TREE DR STE 10
MEMPHIS TN
38115-0300
US

V. Phone/Fax

Practice location:
  • Phone: 901-683-0024
  • Fax: 901-683-0086
Mailing address:
  • Phone: 901-922-5951
  • Fax: 901-922-5952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35089
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number35089
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: