Provider Demographics
NPI:1063610715
Name:VILLALOBOS, JOSE LUIS JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:VILLALOBOS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4970 N EXPRESSWAY STE B
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4269
Mailing Address - Country:US
Mailing Address - Phone:956-609-4430
Mailing Address - Fax:956-446-9902
Practice Address - Street 1:4970 N EXPRESSWAY STE B
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4269
Practice Address - Country:US
Practice Address - Phone:956-609-4430
Practice Address - Fax:956-446-9902
Is Sole Proprietor?:No
Enumeration Date:2007-07-04
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08634000207R00000X
TXN7597207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2T4390OtherPTAN
TX281999706Medicaid
TXTXB154232Medicare PIN