Provider Demographics
NPI:1700818721
Name:VILLAMIL RODRIGUEZ, JOSE RAMON (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:RAMON
Last Name:VILLAMIL RODRIGUEZ
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 1824
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-1824
Mailing Address - Country:US
Mailing Address - Phone:787-740-2670
Mailing Address - Fax:787-786-2988
Practice Address - Street 1:BAYAMON MEDICAL PLAZA
Practice Address - Street 2:SUITE 408
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-740-2670
Practice Address - Fax:787-786-2988
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6025207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE-67500Medicare UPIN
PR97514Medicare ID - Type UnspecifiedPROVIDER NUMBER