Basic Information
| Provider Information | |||||||||
| NPI: | 1922090877 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VILLARREAL | ||||||||
| FirstName: | MIGUEL | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5865 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794085865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432898 | ||||||||
| FaxNumber: | 8067432787 | ||||||||
| Practice Location | |||||||||
| Address1: | 3601 4TH ST | ||||||||
| Address2: | SUITE 1C143 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794308143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432757 | ||||||||
| FaxNumber: | 8067432563 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2005 | ||||||||
| LastUpdateDate: | 01/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | L5171 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8F3613 | 01 | TX | BCBS | OTHER | 91179 | 01 | NM | PRESBYTERIAN COMMERCIAL | OTHER | 170269801 | 05 | TX | MEDICAID | 81682824 | 05 | NM | MEDICAID | 200046320A | 05 | OK | MEDICAID | 87819Z | 01 | TX | HMO BLUE | OTHER | 141416100 | 01 | TX | FIRSTCARE COMMERCIAL | OTHER | 141416101 | 05 | TX | MEDICAID | 91179 | 05 | NM | MEDICAID | A596 | 01 | NM | TRIWEST | OTHER |