Provider Demographics
NPI:1033199542
Name:VILLARREAL, PATRICIO T (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIO
Middle Name:T
Last Name:VILLARREAL
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 1:2310 E HIGHWAY 97
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064-6516
Mailing Address - Country:US
Mailing Address - Phone:830-281-2868
Mailing Address - Fax:830-281-8521
Practice Address - Street 1:1905 HIGHWAY 97 E
Practice Address - Street 2:EMERGENCY ROOM
Practice Address - City:JOURDANTON
Practice Address - State:TX
Practice Address - Zip Code:78026-1504
Practice Address - Country:US
Practice Address - Phone:830-769-5204
Practice Address - Fax:830-769-5206
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0336207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139610305Medicaid
TX0083GGOtherBCBS
TXF32224Medicare UPIN
TX930126235Medicare PIN
TX0013ATMedicare PIN