Provider Demographics
NPI:1023274297
Name:VILLEDA, EDUARDO JAVIER (MD)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:JAVIER
Last Name:VILLEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EDUARDO
Other - Middle Name:VILLEDA
Other - Last Name:MONTENEGRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1701 PELHAM RD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-3353
Mailing Address - Country:US
Mailing Address - Phone:256-365-2416
Mailing Address - Fax:256-365-2426
Practice Address - Street 1:1701 PELHAM RD S
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-3353
Practice Address - Country:US
Practice Address - Phone:256-365-2416
Practice Address - Fax:256-365-2426
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.29053207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine