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NPI Code Detail

MEDICARE: LUIS ANGEL DUHARTE VIDAURRE MD

MEDICARE: LUIS ANGEL DUHARTE VIDAURRE MD
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
1207RI0200XInfectious Disease PhysicianV8475TX
2207RI0200XInfectious Disease PhysicianME95160FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00316333OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
152551OTHERFLBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225076797
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUIS ANGEL DUHARTE VIDAURRE MD
Provider Business Mailing Address
First Line : 2700 E 29TH ST STE 260
Second Line :
City : BRYAN
State : TX
Zip : 77802-2587
Country : US
Telephone Number : 979-690-4816
Fax Number : 979-690-4827
Provider Business Practice Location Address
First Line : 2700 E 29TH ST STE 260
Second Line :
City : BRYAN
State : TX
Zip : 77802-2587
Country : US
Telephone Number : 979-690-4816
Fax Number : 979-690-4827
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2006
Last Update Date : 04/27/2026

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Directions to “ LUIS ANGEL DUHARTE VIDAURRE MD” Practice Location

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