Healthcare Provider Details

I. General information

NPI: 1952393381
Provider Name (Legal Business Name): CHRISTOPHER VILLARREAL P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E MAIN ST
ANTLERS OK
74523-3262
US

IV. Provider business mailing address

PO BOX 518
ANTLERS OK
74523-0518
US

V. Phone/Fax

Practice location:
  • Phone: 580-298-3341
  • Fax: 580-298-2206
Mailing address:
  • Phone: 580-298-3341
  • Fax: 580-298-2206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA05868
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1691888
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: