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General NPI Number Information
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NPI Number | 1225076797
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Entity Type | Individual
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Provider Name | LUIS ANGEL DUHARTE VIDAURRE MD
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Gender | Male
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 2700 E 29TH ST STE 240
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City | BRYAN
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State | TX
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Zip | 77802-2586
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Country | US
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Telephone | 979-690-5816
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Fax | 979-690-4847
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Provider Business Mailing Address
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Address Line | 130 MEDICAL CENTER AVE
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City | SEBRING
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State | FL
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Zip | 33870-5463
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Country | US
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Telephone | 863-314-0004
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Fax | 863-304-8284
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | ME95160
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | V8475
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License Number State | TX
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