Individual ProviderReginald Dale VilleponteauxInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address3333 Silas Creek Pkwy, Attn: Ipof, Winston-Salem, NC 27103-3013(336) 718-7080(336) 277-2436PECOS EnrollmentBased on the most recent information from CMS, provider Reginald Dale Villeponteaux does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1770544918Provider TypeIndividualFull NameVilleponteaux, Reginald DaleCredentialMDGenderMaleSole ProprietorNoEnumeration Date3/29/2006Last Updated7/8/2007Contact InformationPractice LocationPractice Address3333 Silas Creek Pkwy, Attn: Ipof, Winston-Salem, NC 27103-3013Phone(336) 718-7080FaxUnlisted FaxMailing LocationMailing Address2000 Frontis Plaza Blvd Ste 200, Attn Forsyth Medical Group, Winston Salem, NC 27103-5616Phone(336) 277-2436FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense30506North CarolinaProvider IdentifiersIDDescriptionIssuerID7985078DescriptionMedicaidIssuerUnlistedNorth Carolina