Healthcare Provider Details

I. General information

NPI: 1053322842
Provider Name (Legal Business Name): NOEL VILLAROSA GARCIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 E MADISON ST
HOUSTON MS
38851-2417
US

IV. Provider business mailing address

PO BOX 648
HOUSTON MS
38851-0648
US

V. Phone/Fax

Practice location:
  • Phone: 662-448-6213
  • Fax: 662-448-6215
Mailing address:
  • Phone: 662-448-6213
  • Fax: 662-448-6215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number14616
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: