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General NPI Number Information
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NPI Number | 1255909230
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Entity Type | Individual
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Provider Name | RILEY VAN VELSOR MD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 1351 W CENTRAL PARK AVE
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City | DAVENPORT
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State | IA
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Zip | 52804-1853
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Country | US
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Telephone | 563-421-0480
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Fax |
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Provider Business Mailing Address
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Address Line | 7553 SW 58TH LN APT 317
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City | GAINESVILLE
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State | FL
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Zip | 32608-4997
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Country | US
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Telephone | 309-368-7297
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Fax |
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MD-54314
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License Number State | IA
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