Individual
DR. JUAN MANUAL VILLARREAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
250 PARK ST, BOWLING GREEN, KY 42101-1760
(270) 745-1000
(270) 393-1913
Mailing address
350 PARK ST, STE 203 B, BOWLING GREEN, KY 42101-1784
(270) 393-1912
(270) 393-1913
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
29019
KY
207LP2900X
Pain Medicine (Anesthesiology) Physician
29019
KY
208VP0000X
Pain Medicine Physician
29019
KY
208VP0014X
Interventional Pain Medicine Physician
29019
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050061640
RAILROAD MEDICARE
KY
05
—
64290190
—
KY
Enumeration date
09/09/2005
Last updated
09/01/2009
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