Healthcare Provider Details

I. General information

NPI: 1205333838
Provider Name (Legal Business Name): CHARLES REMIE VIDRINE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FAMILY MEDICINE ASSOCIATES OF OAKDALE 105 N HOSPITAL DRIVE
OAKDALE LA
71463-3034
US

IV. Provider business mailing address

FAMILY MEDICINE ASSOCIATES OF OAKDALE 105 N HOSPITAL DRIVE
OAKDALE LA
71463-3034
US

V. Phone/Fax

Practice location:
  • Phone: 318-335-4321
  • Fax: 318-335-4908
Mailing address:
  • Phone: 318-335-4321
  • Fax: 318-335-4908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number321216
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number321213
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number321216
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: