Provider Demographics
NPI:1790897411
Name:VILLANUEVA, RAMON (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:VILLANUEVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:604 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-2708
Mailing Address - Country:US
Mailing Address - Phone:423-337-4508
Mailing Address - Fax:423-337-4588
Practice Address - Street 1:604 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874-2708
Practice Address - Country:US
Practice Address - Phone:423-337-4508
Practice Address - Fax:423-337-4588
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000009592174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3189845Medicare PIN
TNB04402Medicare UPIN
TN3189845Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER