Provider Demographics
NPI:1710207378
Name:VILLEGAS, GUSTAVO V (MD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:V
Last Name:VILLEGAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2603 MICHAEL ANGELO DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-1417
Mailing Address - Country:US
Mailing Address - Phone:956-362-8767
Mailing Address - Fax:956-362-2548
Practice Address - Street 1:2603 MICHAEL ANGELO DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1417
Practice Address - Country:US
Practice Address - Phone:956-362-8767
Practice Address - Fax:956-362-2548
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2018-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXQ5296208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX349165602Medicaid
TX349165601Medicaid