Provider Demographics
NPI:1568185783
Name:JOSE L. VILLALOBOS, JR. , MD, PA
Entity Type:Organization
Organization Name:JOSE L. VILLALOBOS, JR. , MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:VILLALOBOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:956-755-9614
Mailing Address - Street 1:4970 N EXPRESSWAY STE B
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4269
Mailing Address - Country:US
Mailing Address - Phone:956-609-4430
Mailing Address - Fax:956-446-9902
Practice Address - Street 1:4970 N EXPRESSWAY STE B
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4269
Practice Address - Country:US
Practice Address - Phone:956-609-4430
Practice Address - Fax:956-446-9902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2T4368OtherPTAN
TX461653401Medicaid