Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | ME88469 | FL |
NPI | 1003804485 |
---|---|
Provider Name | Augusto E Villegas |
First Address | Fort Myers, FL 33916-2216 |
Second Address | Fleming Island, FL 32003-4831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 24/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16168 | BC BS (01) | FL |
274685900 | (05) | FL |
440667962H | (05) | GA |
7013828 | AETNA (01) | FL |
H10926 | (02) |