Healthcare Provider Details

I. General information

NPI: 1548903933
Provider Name (Legal Business Name): GONZALO MAURICIO GARCIA VILLEGAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GONZALO MAURICIO GARCIA M.D.

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 W 32ND ST
JOPLIN MO
64804-3503
US

IV. Provider business mailing address

1102 W 32ND ST
JOPLIN MO
64804-3503
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-1111
  • Fax:
Mailing address:
  • Phone: 417-347-1111
  • Fax: 314-464-2278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2025026932
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2025026932
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: