Organization
RANDY VILLANUEVA MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY JOSEPH LEE VILLANUEVA MD (OWNER/PRESIDENT)
(901) 590-0103
Entity
Organization
Contact information
Practice address
3025 N WINDSTONE WAY LN, GERMANTOWN, TN 38138-7383
(901) 590-0103
Mailing address
3025 N WINDSTONE WAY LN, GERMANTOWN, TN 38138-7383
(901) 590-0103
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
39777
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39777
MD LICENSE
TN
Enumeration date
09/04/2008
Last updated
09/09/2008
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