Provider Demographics
NPI:1376515742
Name:VILLARD, CHRISTOPHER LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LYNN
Last Name:VILLARD
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 1:1027 N DEMAREE ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4117
Mailing Address - Country:US
Mailing Address - Phone:559-733-5050
Mailing Address - Fax:559-733-8954
Practice Address - Street 1:1027 N DEMAREE ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4117
Practice Address - Country:US
Practice Address - Phone:559-733-5050
Practice Address - Fax:559-733-8954
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39785207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G397850Medicaid
CA00G397850Medicare PIN
CAA47963Medicare UPIN