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General NPI Number Information
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NPI Number | 1497754154
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Entity Type | Organization
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Legal Business Name | ANDRES R VILLAR MD
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 07/22/2021
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Provider Practice Location Address
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Address Line | 789 W DUVAL ST
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City | LAKE CITY
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State | FL
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Zip | 32055-3811
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Country | US
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Telephone | 386-755-1546
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Fax | 386-755-2283
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Provider Business Mailing Address
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Address Line | PO BOX 606
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City | GLEN ST MARY
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State | FL
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Zip | 32040-0606
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Country | US
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Telephone | 904-653-1818
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Fax | 904-653-1814
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. ANDRES R VILLAR
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Credential | MD
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Telephone | 386-755-5044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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