Provider Demographics
NPI:1215100425
Name:JORDAN VILLEGAS, ALEJANDRO (MD)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:JORDAN VILLEGAS
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 1:60 W GORE STREET
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1101
Mailing Address - Country:US
Mailing Address - Phone:407-481-7360
Mailing Address - Fax:407-481-7361
Practice Address - Street 1:60 W GORE STREET
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1101
Practice Address - Country:US
Practice Address - Phone:407-481-7360
Practice Address - Fax:407-481-7361
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1012672080P0208X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME101267OtherMEDICAL LICENSE
FL003502400Medicaid
FL003502400Medicaid