Provider Demographics
NPI:1669451548
Name:VILLAMIL, ALFONSO (MD)
Entity Type:Individual
Prefix:
First Name:ALFONSO
Middle Name:
Last Name:VILLAMIL
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:PO BOX 81346
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78468-1346
Mailing Address - Country:US
Mailing Address - Phone:361-887-0067
Mailing Address - Fax:361-883-1484
Practice Address - Street 1:1625 RODD FIELD RD
Practice Address - Street 2:SUITE C
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4926
Practice Address - Country:US
Practice Address - Phone:361-887-0067
Practice Address - Fax:361-883-1484
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1120207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045303702Medicaid
TX5275216OtherAETNA
TX8G2170OtherBLUE CROSS BLUE SHIELD
TX045303702Medicaid
TX8608B6Medicare PIN
TX8G2170OtherBLUE CROSS BLUE SHIELD