Healthcare Provider Details

I. General information

NPI: 1497104475
Provider Name (Legal Business Name): HANS CHRISTIAN CANCEL VILLAMIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 S MAIN ST
TRENTON FL
32693
US

IV. Provider business mailing address

23343 NW COUNTY ROAD 236
HIGH SPRINGS FL
32643-9669
US

V. Phone/Fax

Practice location:
  • Phone: 352-463-2374
  • Fax: 352-463-2726
Mailing address:
  • Phone: 386-454-0698
  • Fax: 386-454-0690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME142435
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: