Provider Demographics
NPI:1194873786
Name:VILLANUEVA, NOEL FELICIANO (MD)
Entity type:Individual
Prefix:DR
First Name:NOEL
Middle Name:FELICIANO
Last Name:VILLANUEVA
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:PO BOX 9575
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79708-9575
Mailing Address - Country:US
Mailing Address - Phone:432-580-7440
Mailing Address - Fax:
Practice Address - Street 1:850 TOWER DR STE 111
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4252
Practice Address - Country:US
Practice Address - Phone:432-580-7440
Practice Address - Fax:432-580-7730
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7717208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138040405Medicaid
TX138040405Medicaid
TXA11320Medicare UPIN