Provider Demographics
NPI:1467050120
Name:VILLERT, EDWIN FRANCOIS XAVIER (PA)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:FRANCOIS XAVIER
Last Name:VILLERT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1028 SLATER RD APT 201
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8468
Mailing Address - Country:US
Mailing Address - Phone:904-844-1594
Mailing Address - Fax:
Practice Address - Street 1:MATRIX OCCUPATIONAL HEALTH PC
Practice Address - Street 2:1110 KILDAIRE FARM ROAD
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511
Practice Address - Country:US
Practice Address - Phone:919-481-0277
Practice Address - Fax:919-481-9777
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113585363A00000X
NC0010-12221363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant