Provider Demographics
NPI:1952634461
Name:VILLAMOR, NOSTER (RPT)
Entity Type:Individual
Prefix:
First Name:NOSTER
Middle Name:
Last Name:VILLAMOR
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 US 27 S
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-7918
Mailing Address - Country:US
Mailing Address - Phone:863-465-4412
Mailing Address - Fax:863-465-7790
Practice Address - Street 1:123 US 27 S
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-7918
Practice Address - Country:US
Practice Address - Phone:863-465-4412
Practice Address - Fax:863-465-7790
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7249208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00907877OtherRAILROAD MC
FLY7382OtherBLUECROSS/BLUESHIELD OF FLORIDA
FLY7382OtherBLUECROSS/BLUESHIELD OF FLORIDA