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General NPI Number Information
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NPI Number | 1528107406
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Entity Type | Individual
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Provider Name | JOSE IVAN VELA-HERNANDEZ D.O.
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Gender | Male
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 05/05/2020
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Provider Practice Location Address
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Address Line | HHS CENTRALIZED VERIFICATION/MEDICAL STAFF SERVICES 1120 S UTICA AVE
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City | TULSA
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State | OK
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Zip | 74104
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Country | US
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Telephone | 918-579-2528
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Fax |
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Provider Business Mailing Address
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Address Line | 10501 CASTLETON ST
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City | FORT SMITH
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State | AR
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Zip | 72908-9394
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Country | US
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Telephone | 918-344-6952
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | E-4412
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 4375
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License Number State | OK
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