MEDICARE: MR. JUAN RUBEN VILLAZON M.D.

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	174400000X	Specialist	17566	OK

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

General Provider Information

NPI Number	:	1174515605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUAN RUBEN VILLAZON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1137
Second Line	:
City	:	ALTUS
State	:	OK
Zip	:	73522-1137
Country	:	US
Telephone Number	:	580-481-2325
Fax Number	:	580-482-0091

Provider Business Practice Location Address
First Line	:	219 E COMMERCE ST
Second Line	:
City	:	ALTUS
State	:	OK
Zip	:	73521-3913
Country	:	US
Telephone Number	:	580-481-2325
Fax Number	:	580-482-0091

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	12/17/2012

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Directions to “ MR. JUAN RUBEN VILLAZON M.D.” Practice Location

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