MEDICARE: DR. STEVEN B VIDRINE 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
1	207Q00000X	Family Medicine Physician	019490	LA

Other Identifiers

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

General Provider Information

NPI Number	:	1720125511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN B VIDRINE MD

Provider Business Mailing Address
First Line	:	417 E LINCOLN RD
Second Line	:
City	:	VILLE PLATTE
State	:	LA
Zip	:	70586-3431
Country	:	US
Telephone Number	:	337-363-8033
Fax Number	:	337-363-4571

Provider Business Practice Location Address
First Line	:	417 E LINCOLN RD
Second Line	:
City	:	VILLE PLATTE
State	:	LA
Zip	:	70586-3431
Country	:	US
Telephone Number	:	337-363-8033
Fax Number	:	337-363-4571

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/03/2024

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