MEDICARE: JOSE MARIA VIDAL 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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	H2186	TX

General Provider Information

NPI Number	:	1790707982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE MARIA VIDAL M.D.

Provider Business Mailing Address
First Line	:	6800 IH-10 WEST
Second Line	:	SUITE 300
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-2011
Country	:	US
Telephone Number	:	210-616-0008
Fax Number	:	210-616-0231

Provider Business Practice Location Address
First Line	:	6800 IH-10 WEST
Second Line	:	SUITE 300
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-2011
Country	:	US
Telephone Number	:	210-616-0008
Fax Number	:	210-616-0231

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	10/30/2009

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