Provider Demographics
NPI:1003804287
Name:VILLAR, MARY JO (DO)
Entity Type:Individual
Prefix:
First Name:MARY JO
Middle Name:
Last Name:VILLAR
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:7600 W 20TH AVE
Mailing Address - Street 2:STE 103-104
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1821
Mailing Address - Country:US
Mailing Address - Phone:305-231-3150
Mailing Address - Fax:305-231-5020
Practice Address - Street 1:7600 W 20TH AVE
Practice Address - Street 2:STE 103-104
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1821
Practice Address - Country:US
Practice Address - Phone:305-231-3150
Practice Address - Fax:305-231-5020
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2015-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL0S 7470207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258647900Medicaid
FLE4574Medicare PIN
FLH24474Medicare UPIN