Provider Demographics
NPI:1891183349
Name:DAVID F VILLACRES MDPA
Entity Type:Organization
Organization Name:DAVID F VILLACRES MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:VILLACRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-361-5990
Mailing Address - Street 1:3407 RIVERS EDGE TRL
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2634
Mailing Address - Country:US
Mailing Address - Phone:281-361-5990
Mailing Address - Fax:281-361-5883
Practice Address - Street 1:3407 RIVERS EDGE TRL
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2634
Practice Address - Country:US
Practice Address - Phone:281-361-5990
Practice Address - Fax:281-361-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00K35UOtherMEDICARE PTAN
TX089831402Medicaid