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General NPI Number Information
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NPI Number | 1598029704
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Entity Type | Individual
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Provider Name | JOHN PAUL VELASCO M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/02/2012
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 4614 COUNTRY CLUB RD
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City | WINSTON SALEM
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State | NC
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Zip | 27104-3520
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Country | US
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Telephone | 336-716-3787
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Fax | 336-716-0222
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Provider Business Mailing Address
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Address Line | PO BOX 602658
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City | CHARLOTTE
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State | NC
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Zip | 28260-2658
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Country | US
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Telephone | 336-716-2011
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2015-01625
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License Number State | NC
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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 | 84941
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License Number State | WI
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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 | 4301100843
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036.174129
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2015-01625
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License Number State | NC
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