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General NPI Number Information
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NPI Number | 1164632717
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Entity Type | Individual
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Provider Name | RAFAEL VELASQUEZ MD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 12150 SEMINOLE BLVD
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City | LARGO
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State | FL
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Zip | 33778-2833
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Country | US
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Telephone | 727-216-6188
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Fax | 727-216-6242
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Provider Business Mailing Address
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Address Line | 5400 PINEHURST DR
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City | SPRING HILL
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State | FL
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Zip | 34606-3833
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Country | US
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Telephone | 352-277-5348
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Fax | 352-606-2857
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L2694
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 04-33895
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME119208
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License Number State | FL
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