Provider Demographics
NPI:1003804485
Name:VILLEGAS, AUGUSTO E (MD)
Entity Type:Individual
Prefix:
First Name:AUGUSTO
Middle Name:E
Last Name: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:PO BOX 102222
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:813-976-7895
Practice Address - Street 1:4689 US HIGHWAY 17 STE 2-5
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4831
Practice Address - Country:US
Practice Address - Phone:904-269-6526
Practice Address - Fax:904-269-6527
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88469207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274685900Medicaid
FL7013828OtherAETNA
FL16168OtherBC BS
GA440667962HMedicaid
FL16168SMedicare PIN
FL7013828OtherAETNA
FL274685900Medicaid
FL16168UMedicare PIN