Doctor Name: | DANNY JESUS VILLALOBOS |
NPI Number: | 1194916569 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 1077657 |
Business Practice Address: | 301 Fisher St Keesler Afb, MS - 395342508 |
Business Phone Number: | 2283760440 |
Business Fax Number: | |
Mailing Address: | 301 Fisher St, KEESLER AFB |
State: | MS |
Postal Code: | 395342508 |
Phone Number: | 2283760440 |
Fax Number: | |
NPI Enumeration Date: | 08/09/2007 |
NPI Last Update Date: | 08/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 1077657 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |