Provider Demographics
NPI:1972729945
Name:GUSTAVO E. VILLARREAL, M.D., P. A.
Entity type:Organization
Organization Name:GUSTAVO E. VILLARREAL, M.D., P. A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:E
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-722-8484
Mailing Address - Street 1:208 SHILOH DR STE 1
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-7402
Mailing Address - Country:US
Mailing Address - Phone:956-722-8484
Mailing Address - Fax:956-727-8494
Practice Address - Street 1:208 SHILOH DR STE 1
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-7402
Practice Address - Country:US
Practice Address - Phone:956-722-8484
Practice Address - Fax:956-727-8494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6038207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079740901Medicaid
TX00061NMedicare PIN
TXB27329Medicare UPIN