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General NPI Number Information
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NPI Number | 1336120484
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Entity Type | Organization
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Legal Business Name | JOHN PAUL VIDOLIN M D P A
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Dates
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Enumeration Date | 11/07/2005
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Last Update Date | 12/18/2009
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Provider Practice Location Address
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Address Line | 836 SUNSET LAKE BLVD STE 102
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City | VENICE
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State | FL
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Zip | 34292-7555
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Country | US
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Telephone | 941-497-1771
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Fax | 941-497-1860
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Provider Business Mailing Address
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Address Line | STE 102 836 SUNSET LAKE BLVD
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City | VENICE
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State | FL
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Zip | 34292-7555
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Country | US
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Telephone | 941-497-1771
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Fax | 941-497-1860
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Authorized Official
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Title or Position | CFO
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Name | JOHN PAUL VIDOLIN
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Credential | MD
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Telephone | 941-497-1771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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