Individual
MR. JUAN RUBEN VILLAZON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
219 E COMMERCE ST, ALTUS, OK 73521-3913
(580) 481-2325
(580) 482-0091
Mailing address
PO BOX 1137, ALTUS, OK 73522-1137
(580) 481-2325
(580) 482-0091
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
17566
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100021950A
—
OK
Enumeration date
08/19/2005
Last updated
12/17/2012
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