Provider Demographics
NPI:1548376791
Name:VELASCO, ROBERTO ALFILER JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:ALFILER
Last Name:VELASCO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6044 MARTIN LUTHER KING JR WAY S STE 104
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3179
Mailing Address - Country:US
Mailing Address - Phone:206-723-9853
Mailing Address - Fax:206-723-0849
Practice Address - Street 1:6044 MARTIN LUTHER KING JR WAY S STE 104
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3179
Practice Address - Country:US
Practice Address - Phone:206-723-9853
Practice Address - Fax:206-723-0849
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50D0934866OtherCLIA
WA911488790OtherCOMMERCIAL
WAWA7289OtherHMO
WA010743OtherPPO
WA1011592Medicaid
VE4004OtherREGENCE
WA7033046Medicaid
WAG8856997Medicare ID - Type Unspecified
WA7033046Medicaid
WA010743OtherPPO