Provider Demographics
NPI:1417121849
Name:VILLAMOR, A COLLINS (MD)
Entity type:Individual
Prefix:
First Name:A
Middle Name:COLLINS
Last Name:VILLAMOR
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 1:2416 W ESPARTERO WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-5525
Mailing Address - Country:US
Mailing Address - Phone:623-237-3440
Mailing Address - Fax:480-685-8379
Practice Address - Street 1:2635 N DYSART RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-2001
Practice Address - Country:US
Practice Address - Phone:623-237-3440
Practice Address - Fax:480-685-8379
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47017207RH0002X, 207RH0002X, 207RH0002X, 207R00000X
FLME109246207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z183002OtherMEDICARE INDIVIDUAL PTAN
AZ804009Medicaid
AZ804009Medicaid