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General NPI Number Information
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NPI Number | 1790974244
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Entity Type | Organization
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Legal Business Name | MIDWEST GASTROENTEROLOGY CONSULTANTS, P.C.
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 08/22/2014
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Provider Practice Location Address
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Address Line | 13276 MANCHESTER RD
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City | SAINT LOUIS
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State | MO
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Zip | 63131-1706
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Country | US
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Telephone | 314-822-9733
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Fax |
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Provider Business Mailing Address
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Address Line | 13276 MANCHESTER RD
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City | SAINT LOUIS
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State | MO
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Zip | 63131-1706
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Country | US
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Telephone | 314-822-9733
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Fax |
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Authorized Official
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Title or Position | PESIDENT/OWNER
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Name | DR. HUGO A VILLARREAL
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Credential | M.D.
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Telephone | 214-822-9733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 103770
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License Number State | MO
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