Provider Demographics
NPI:1114295722
Name:VILLAFUERTE, PATRICK GERARD (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:GERARD
Last Name:VILLAFUERTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:613 23RD ST STE 310
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2877
Practice Address - Country:US
Practice Address - Phone:606-833-2161
Practice Address - Fax:606-833-2162
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY46913207RI0200X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0108383Medicaid
KY7100315300Medicaid
KYP01386216OtherRR MEDICARE
KY7100315300Medicaid