MEDICARE: AUGUSTO E VILLEGAS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RX0202X	Medical Oncology Physician	ME88469	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	7013828	OTHER	FL	AETNA
3	16168	OTHER	FL	BC BS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003804485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUGUSTO E VILLEGAS MD

Provider Business Mailing Address
First Line	:	PO BOX 102222
Second Line	:	ATTN: CREDENTIALING
City	:	ATLANTA
State	:	GA
Zip	:	30368-2222
Country	:	US
Telephone Number	:	239-274-8200
Fax Number	:	813-976-7895

Provider Business Practice Location Address
First Line	:	4689 US HIGHWAY 17 STE 2-5
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-4831
Country	:	US
Telephone Number	:	904-269-6526
Fax Number	:	904-269-6527

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	09/02/2022

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Directions to “ AUGUSTO E VILLEGAS MD” Practice Location

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