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General NPI Number Information
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NPI Number | 1902571532
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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 | 08/16/2021
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Last Update Date | 03/07/2022
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Provider Practice Location Address
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Address Line | 1002 11TH ST SW
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City | LIVE OAK
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State | FL
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Zip | 32064-3606
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Country | US
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Telephone | 386-364-8050
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Fax |
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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 | 386-755-5044
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | 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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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