Provider Demographics
NPI:1508934555
Name:VILLEGAS, LEONARDO (MD)
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:
Last Name:VILLEGAS
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 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6014
Mailing Address - Fax:904-450-6401
Practice Address - Street 1:730 BAYFRONT PKWY STE 5A
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-6250
Practice Address - Country:US
Practice Address - Phone:850-432-5488
Practice Address - Fax:850-432-5228
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-01041208600000X
390200000X
FLME1107572086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14FC8OtherBCBSFL
AL592-21627OtherBCBS
FL003997200Medicaid
FLFI669ZMedicare PIN