Provider Demographics
NPI:1265546287
Name:VILLEGAS, ROBERTO JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:VILLEGAS
Suffix:JR
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 1:2320 MIDDLECOFF LN
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8159
Mailing Address - Country:US
Mailing Address - Phone:956-795-1440
Mailing Address - Fax:956-795-0092
Practice Address - Street 1:10710 MCPHERSON RD
Practice Address - Street 2:SUITE 204
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6271
Practice Address - Country:US
Practice Address - Phone:956-795-1440
Practice Address - Fax:956-795-0092
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5942208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159234703Medicaid
TX159234702Medicaid
TX159234701Medicaid
TX159234701Medicaid