Healthcare Provider Details

I. General information

NPI: 1790281400
Provider Name (Legal Business Name): ERIC DAVID VILLARREAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 MORTON PLANT ST STE 301
CLEARWATER FL
33756-3395
US

IV. Provider business mailing address

5901 E FOWLER AVE STE 100
TEMPLE TERRACE FL
33617-2305
US

V. Phone/Fax

Practice location:
  • Phone: 727-461-6026
  • Fax:
Mailing address:
  • Phone: 813-978-9700
  • Fax: 813-558-6939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberDR.0070341
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME164109
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: