Provider Demographics
NPI:1134205297
Name:VILLEGAS, MARY ANNE (MD)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANNE
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 692049
Mailing Address - Street 2:ASSOCIATES IN DERMATOLOGY
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32869
Mailing Address - Country:US
Mailing Address - Phone:407-846-7546
Mailing Address - Fax:407-933-1001
Practice Address - Street 1:725 E OAK STREET
Practice Address - Street 2:ASSOCIATES IN DERMATOLOGY
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744
Practice Address - Country:US
Practice Address - Phone:407-846-7546
Practice Address - Fax:704-933-1001
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME67953207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF65967Medicare UPIN
FL44835YMedicare ID - Type Unspecified