1235204173 NPI number — DR. EUGENE A VELEY MD

Table of content: DR. EUGENE A VELEY MD (NPI 1235204173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235204173 NPI number — DR. EUGENE A VELEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VELEY
Provider First Name:
EUGENE
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VELEY
Provider Other First Name:
GENE
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1235204173
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 WENDOVER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHLAKE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76092-8589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-886-9433
Provider Business Mailing Address Fax Number:
682-688-7744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1643 LANCASTER DR STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAPEVINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76051-3593
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-886-8552
Provider Business Practice Location Address Fax Number:
682-688-7744
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  232772 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: P3093 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PENDING , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1019432100001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1967484 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 00246075 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: PENDING . This is a "BCBSTX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com