Doctor Name: | JUANITO L VILLAHERMOSA |
NPI Number: | 1306814090 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 32529 |
Business Practice Address: | 803 Hwy 71 West Savannah, MO - 644851151 |
Business Phone Number: | 8063243121 |
Business Fax Number: | 8163243122 |
Mailing Address: | 803 Hwy 71 West, SAVANNAH |
State: | MO |
Postal Code: | 644851151 |
Phone Number: | 8063243121 |
Fax Number: | 8163243122 |
NPI Enumeration Date: | 03/09/2006 |
NPI Last Update Date: | 06/19/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 32529 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |