MEDICARE: LEO VILLAROMAN, MD, 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	207Q00000X	Family Medicine Physician	N1208	TX

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	:	1609020452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEO VILLAROMAN, MD, PA

Provider Business Mailing Address
First Line	:	3303 CRESTMONT DR
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79707-4234
Country	:	US
Telephone Number	:	432-687-6203
Fax Number	:	432-687-6299

Provider Business Practice Location Address
First Line	:	501 GOLDER AVE
Second Line	:	SUITE 203
City	:	ODESSA
State	:	TX
Zip	:	79761-4411
Country	:	US
Telephone Number	:	432-687-6203
Fax Number	:	432-687-6299

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEO D VILLAROMAN
Credential	:	MD
Telephone Number	:	432-687-6203

Provider Enumeration Date	:	11/06/2008
Last Update Date	:	01/13/2009

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