Healthcare Provider Details

I. General information

NPI: 1356541197
Provider Name (Legal Business Name): JAIME LUIS VELASCO MASSON M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAIME LUIS VELASCO M.D

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17600 INTERSTATE 45 S
THE WOODLANDS TX
77384-5148
US

IV. Provider business mailing address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

V. Phone/Fax

Practice location:
  • Phone: 314-268-4101
  • Fax: 314-577-5379
Mailing address:
  • Phone: 314-268-4101
  • Fax: 314-577-5379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1732
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberC1732
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberR6499
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number44190
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR6499
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number4301096765
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301096765
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2013021824
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: