Provider Demographics
NPI:1154418119
Name:VILLARREAL, HUGO A (MD)
Entity type:Individual
Prefix:
First Name:HUGO
Middle Name:A
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13276 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1706
Mailing Address - Country:US
Mailing Address - Phone:314-822-9733
Mailing Address - Fax:314-822-9838
Practice Address - Street 1:13276 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1706
Practice Address - Country:US
Practice Address - Phone:314-822-9733
Practice Address - Fax:314-822-9838
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103770207RG0100X
IL036-086874207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO110214224OtherRR MEDICARE MO AREA 99
MO132551OtherBCBS MO
IL04227854OtherBCBS IL
MO41206V41207OtherGHP (ALL PLANS)
MO431907959OtherTRICARE
MS5173V22657OtherHEALTH CARE USA
MO951940001OtherMEDICARE99
MO288486OtherHEALTHLINK
MOF83209OtherMERCY (ALL PLANS)
MO2909029OtherUHC (ALL)
MO5104133OtherAETNA
MO100015334OtherRR MEDICARE MO
MO208254003Medicaid
MO431907959OtherGREAT WEST
IL100015333OtherRR MEDICARE IL
MO95286OtherEXCLUSIVE CHOICE (FMH)
MO100015334OtherRR MEDICARE MO
MO41206V41207OtherGHP (ALL PLANS)
MOF82309Medicare UPIN