Provider Demographics
NPI:1366701369
Name:VILARDO, AGUSTIN (MD)
Entity type:Individual
Prefix:
First Name:AGUSTIN
Middle Name:
Last Name:VILARDO
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:555 N BYRON BUTLER PKWY
Mailing Address - Street 2:TMH PHYSICIAN PARTNERS, PERRY
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32347-2315
Mailing Address - Country:US
Mailing Address - Phone:850-838-8636
Mailing Address - Fax:850-838-3614
Practice Address - Street 1:555 N BYRON BUTLER PKWY
Practice Address - Street 2:TMH PHYSICIAN PARTNERS, PERRY
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-2315
Practice Address - Country:US
Practice Address - Phone:850-838-8636
Practice Address - Fax:850-838-3614
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME123474207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine