Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | M6936 | TX |
NPI | 1013116268 |
---|---|
Provider Name | Mark Timothy Villa |
First Address | Houston, TX 77210-4439 |
Second Address | Houston, TX 77030-4095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2007 |
Last Update Date | 19/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
194016501 | (05) | TX |
P00774920 | RAILROAD MEDICARE (01) | TX |