MEDICARE: ALAN THOMAS VILLAVICENCIO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	DR.0040687	CO

General Provider Information

NPI Number	:	1720033939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN THOMAS VILLAVICENCIO MD

Provider Business Mailing Address
First Line	:	PO BOX 9049
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-9049
Country	:	US
Telephone Number	:	303-938-5700
Fax Number	:	303-998-0007

Provider Business Practice Location Address
First Line	:	2030 MOUNTAIN VIEW AVE STE 210
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-3180
Country	:	US
Telephone Number	:	303-485-3560
Fax Number	:	303-485-3561

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	02/04/2026

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