MEDICARE: JOSE ANGEL VIDAURRE 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
1	207R00000X	Internal Medicine Physician	ME98772	FL

General Provider Information

NPI Number	:	1558589101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE ANGEL VIDAURRE M.D.

Provider Business Mailing Address
First Line	:	3061 E COMMERCIAL BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4311
Country	:	US
Telephone Number	:	954-491-0031
Fax Number	:

Provider Business Practice Location Address
First Line	:	3061 E COMMERCIAL BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4311
Country	:	US
Telephone Number	:	954-491-0031
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	06/08/2010

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