Basic Information
| Provider Information | |||||||||
| NPI: | 1972574051 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VELASQUEZ | ||||||||
| FirstName: | ENRIQUE | ||||||||
| MiddleName: | MARTIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565394080 | ||||||||
| FaxNumber: | 2565394099 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565394080 | ||||||||
| FaxNumber: | 2565394099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 02/04/2010 | ||||||||
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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 | 207RC0000X | 26544 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 111506 | 05 | AL | MEDICAID | P00781672 | 01 | AL | RAILROAD MEDICALRE | OTHER | 111496 | 05 | AL | MEDICAID | 111504 | 05 | AL | MEDICAID | 111499 | 05 | AL | MEDICAID | 111502 | 05 | AL | MEDICAID | 25-00726 | 01 | UNITED HEALTHCARE | OTHER | 510-49303 | 01 | AL | BCBS | OTHER | 51001162 | 01 | AL | BCBS | OTHER | 515-99690 | 01 | AL | BCBS | OTHER | P00233667 | 01 | RAILROAD MEDICARE | OTHER | 510-49304 | 01 | AL | BCBS | OTHER | 510-49702 | 01 | AL | BCBS | OTHER | 7856614 | 01 | AETNA | OTHER | 009992375 | 05 | AL | MEDICAID | 111497 | 05 | AL | MEDICAID | 510-49302 | 01 | AL | BCBS | OTHER | 510-49701 | 01 | AL | BCBS | OTHER | 4109938 | 01 | TN | BCBS | OTHER |