Healthcare Provider Details

I. General information

NPI: 1114295722
Provider Name (Legal Business Name): PATRICK GERARD VILLAFUERTE M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 23RD ST STE 310
ASHLAND KY
41101-2877
US

IV. Provider business mailing address

PO BOX 2379
ASHLAND KY
41105-2379
US

V. Phone/Fax

Practice location:
  • Phone: 606-833-2161
  • Fax: 606-833-2162
Mailing address:
  • Phone: 606-408-6200
  • Fax: 606-408-6612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number46913
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: