MEDICARE: DAVID VILLARREAL 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	208600000X	Surgery Physician	26380	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	020033489	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5969342	OTHER	TN	AETNA
2	3060477	OTHER	TN	BLUE CROSS OF TN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609871821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID VILLARREAL MD

Provider Business Mailing Address
First Line	:	PO BOX 11955
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38308-0132
Country	:	US
Telephone Number	:	731-664-7395
Fax Number	:	731-664-0057

Provider Business Practice Location Address
First Line	:	395 HOSPITAL BLVD
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-2080
Country	:	US
Telephone Number	:	731-664-7395
Fax Number	:	731-664-0057

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	01/08/2013

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Directions to “ DAVID VILLARREAL MD” Practice Location

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