Individual
MARK TIMOTHY VILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4095
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
M6936
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
194016501
—
TX
01
—
P00774920
RAILROAD MEDICARE
TX
Enumeration date
07/17/2007
Last updated
01/19/2010
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