Provider Demographics
NPI:1780721779
Name:ALTUS NEUROLOGY P C
Entity type:Organization
Organization Name:ALTUS NEUROLOGY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:RUBEN
Authorized Official - Last Name:VILLAZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-481-2325
Mailing Address - Street 1:PO BOX 1137
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73522-1137
Mailing Address - Country:US
Mailing Address - Phone:580-481-2325
Mailing Address - Fax:580-482-0091
Practice Address - Street 1:219 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-3913
Practice Address - Country:US
Practice Address - Phone:580-481-2325
Practice Address - Fax:580-482-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty