Basic Information
| Provider Information | |||||||||
| NPI: | 1770593097 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VELASQUEZ | ||||||||
| FirstName: | HERMES | ||||||||
| MiddleName: | SEGUNDO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 36TH ST | ||||||||
| Address2: | |||||||||
| City: | VERO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329604862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7725674311 | ||||||||
| FaxNumber: | 7727941450 | ||||||||
| Practice Location | |||||||||
| Address1: | 3450 11TH CT STE 203 | ||||||||
| Address2: | |||||||||
| City: | VERO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329605012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7727945800 | ||||||||
| FaxNumber: | 7727945801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 19311 | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | ME | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 1455580 | 05 | LA | MEDICAID | 00752396 | 05 | MS | MEDICAID | 011063100 | 05 | FL | MEDICAID | P00346935 | 01 | RAILROAD MEDICARE | OTHER |