Provider Demographics
NPI:1427316132
Name:VILLARREAL, JAIME JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:
Last Name:VILLARREAL
Suffix:JR
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 4624
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4624
Mailing Address - Country:US
Mailing Address - Phone:956-362-6683
Mailing Address - Fax:956-362-6818
Practice Address - Street 1:5540 RAPHAEL DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-362-6683
Practice Address - Fax:956-362-6818
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10043277207X00000X
TXQ9920207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ9920OtherTMB LICENSE