1043220064 NPI number — MR. RHOGER L VILLALON DPT

Table of content: MR. RHOGER L VILLALON DPT (NPI 1043220064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043220064 NPI number — MR. RHOGER L VILLALON DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VILLALON
Provider First Name:
RHOGER
Provider Middle Name:
L
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043220064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
981 HIGH HOUSE RD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27513-3510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-388-0111
Provider Business Mailing Address Fax Number:
919-388-8668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1051 PEMBERTON HILL RD
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
APEX
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27502-4267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-388-0111
Provider Business Practice Location Address Fax Number:
919-388-8668
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  10589 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 21248 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 067X4 . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com