Provider Demographics
NPI:1730155086
Name:VILLARES, ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:VILLARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 E BELL RD STE 206
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2159
Mailing Address - Country:US
Mailing Address - Phone:480-725-8627
Mailing Address - Fax:480-725-8629
Practice Address - Street 1:3811 E BELL RD STE 206
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2159
Practice Address - Country:US
Practice Address - Phone:480-725-8627
Practice Address - Fax:480-725-8629
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32704208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ868466Medicaid
AZH37737Medicare UPIN
AZZ108490Medicare PIN