Provider Demographics
NPI:1053381202
Name:VELA, GARY A (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:VELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 BRICKELL AVE UNIT 4100
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3995
Mailing Address - Country:US
Mailing Address - Phone:437-660-2934
Mailing Address - Fax:
Practice Address - Street 1:730 NW 107TH AVE STE 115
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-3104
Practice Address - Country:US
Practice Address - Phone:786-607-8979
Practice Address - Fax:305-489-8232
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD 00 639002086S0122X
FLME145984208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7269001OtherBLUE CROSS BLUE SHIELD
MD7269001OtherBLUE CROSS BLUE SHIELD
MDI07162Medicare UPIN