Provider Demographics
NPI:1144479254
Name:VILLAMAYOR, FRANK J (PA-C)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:J
Last Name:VILLAMAYOR
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:622 COLLINS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2077
Mailing Address - Country:US
Mailing Address - Phone:636-638-1506
Mailing Address - Fax:636-638-1507
Practice Address - Street 1:2865 JAMES BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2803
Practice Address - Country:US
Practice Address - Phone:573-776-1100
Practice Address - Fax:573-776-1107
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2008002901363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1144479254Medicaid
MO137740009Medicare PIN
MO146640008Medicare PIN
MO1144479254Medicaid
MO146660009Medicare PIN