Provider Demographics
NPI:1346353257
Name:VILLAR, JOSE JULIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:JULIAN
Last Name:VILLAR
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 1:428 NE 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-4717
Mailing Address - Country:US
Mailing Address - Phone:305-895-9551
Mailing Address - Fax:305-895-9553
Practice Address - Street 1:428 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-4717
Practice Address - Country:US
Practice Address - Phone:305-895-9551
Practice Address - Fax:305-895-9553
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2011-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80357208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258739400Medicaid
FL35337Medicare ID - Type Unspecified
FL258739400Medicaid