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NPI Code Detail

MEDICARE: ALEX C VIDAEFF M.D.

MEDICARE: ALEX C VIDAEFF M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207VM0101XMaternal & Fetal Medicine PhysicianMD70097761WA
2207VM0101XMaternal & Fetal Medicine PhysicianBV2407674WA
3207VM0101XMaternal & Fetal Medicine PhysicianL2728TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28A4436OTHERTXBCBS

General Provider Information

NPI Number : 1073560199
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEX C VIDAEFF M.D.
Provider Business Mailing Address
First Line : PO BOX 201088
Second Line :
City : HOUSTON
State : TX
Zip : 77216-1088
Country : US
Telephone Number : 713-500-3500
Fax Number :
Provider Business Practice Location Address
First Line : 1504 TAUB LOOP
Second Line :
City : HOUSTON
State : TX
Zip : 77030-1608
Country : US
Telephone Number : 713-526-4243
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2006
Last Update Date : 05/13/2026

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