MEDICARE: EDWIN FRANCOIS XAVIER VILLERT PA

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	363A00000X	Physician Assistant	PA9113585	FL
2	363A00000X	Physician Assistant	0010-12221	NC

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	:	1467050120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWIN FRANCOIS XAVIER VILLERT PA

Provider Business Mailing Address
First Line	:	1028 SLATER RD APT 201
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-8468
Country	:	US
Telephone Number	:	904-844-1594
Fax Number	:

Provider Business Practice Location Address
First Line	:	MATRIX OCCUPATIONAL HEALTH PC
Second Line	:	1110 KILDAIRE FARM ROAD
City	:	CARY
State	:	NC
Zip	:	27511
Country	:	US
Telephone Number	:	919-481-0277
Fax Number	:	919-481-9777

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

Provider Enumeration Date	:	10/15/2020
Last Update Date	:	10/05/2023

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