Provider Demographics
NPI:1528107406
Name:VELA-HERNANDEZ, JOSE IVAN (DO)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:IVAN
Last Name:VELA-HERNANDEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10501 CASTLETON ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-9394
Mailing Address - Country:US
Mailing Address - Phone:918-344-6952
Mailing Address - Fax:
Practice Address - Street 1:HHS CENTRALIZED VERIFICATION/MEDICAL STAFF SERVICES
Practice Address - Street 2:1120 S UTICA AVE
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104
Practice Address - Country:US
Practice Address - Phone:918-579-2528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4412207L00000X
OK4375207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK900522349OtherMEDICARE GROUP PIN
OK200075040AMedicaid
OK242719208Medicare PIN