MEDICARE: XIOMARA VELAZCO, M.D. P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	N6749	TX

General Provider Information

NPI Number	:	1376857268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	XIOMARA VELAZCO, M.D. P.A.

Provider Business Mailing Address
First Line	:	4800 NE STALLINGS DR.
Second Line	:	SUITE 1500
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1207
Country	:	US
Telephone Number	:	936-715-9470
Fax Number	:	936-715-9475

Provider Business Practice Location Address
First Line	:	4800 NE STALLINGS DR.
Second Line	:	SUITE 1500
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1207
Country	:	US
Telephone Number	:	936-715-9470
Fax Number	:	936-715-9475

Authorized Official
Title or Position	:	OWNER
Name	:	XIOMARA VELAZCO
Credential	:	M.D.
Telephone Number	:	936-715-9470

Provider Enumeration Date	:	08/03/2010
Last Update Date	:	08/03/2010

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