Healthcare Provider Details

I. General information

NPI: 1679519557
Provider Name (Legal Business Name): HERBERT B. VILLAFLORES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12380 DEPAUL DRIVE
BRIDGETON MO
63044
US

IV. Provider business mailing address

1776 WOODSTEAD CT STE 208
THE WOODLANDS TX
77380-1480
US

V. Phone/Fax

Practice location:
  • Phone: 314-447-9700
  • Fax:
Mailing address:
  • Phone: 877-749-7428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2004029831
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: