Individual
DR. JOSE IVAN VELA-HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
HHS CENTRALIZED VERIFICATION/MEDICAL STAFF SERVICES, 1120 S UTICA AVE, TULSA, OK 74104
(918) 579-2528
Mailing address
10501 CASTLETON ST, FORT SMITH, AR 72908-9394
(918) 344-6952
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
4375
OK
207L00000X
Anesthesiology Physician
E-4412
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200075040A
—
OK
01
—
900522349
MEDICARE GROUP PIN
OK
Enumeration date
02/06/2007
Last updated
05/05/2020
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