Individual
DR. GONZALO RAFAEL DE VILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
102 S CHARLES G SEIVERS BLVD, CLINTON, TN 37716-3916
(865) 457-4702
Mailing address
102 S CHARLES G SEIVERS BLVD, CLINTON, TN 37716-3916
(865) 457-4702
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
61482
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q042265
—
TN
Enumeration date
04/12/2017
Last updated
04/27/2021
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