Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 034457L | PA |
NPI | 1285638650 |
---|---|
Provider Name | Dr. Emilio Villegas |
First Address | Irwin, PA 15642-3552 |
Second Address | Irwin, PA 15642-3552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 15/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0608057 | (05) | PA |
580747 | HIGHMARK (01) | |
B37442 | (02) |