Provider Demographics
NPI:1245267343
Name:VILLACRES, DAVID FERNANDO (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:FERNANDO
Last Name:VILLACRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 RIVERS EDGE TRL
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
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:HUMBLE
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
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7099174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089831402Medicaid
00K35UMedicare PIN