Individual
JOSE R VILLAVICENCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
601 ST RT 664, LOGAN, OH 43138
(740) 380-8000
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
(937) 619-4304
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35069935V
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000326505
BCBS
—
01
—
P00139007
HOCKING MEDICARE RR
—
Enumeration date
05/12/2006
Last updated
05/29/2008
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