Provider Demographics
NPI:1003829920
Name:GHIDONI, JOHN JOSEPH III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:GHIDONI
Suffix:III
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:8229 SHOAL CREEK BLVD
Mailing Address - Street 2:SUITE#101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7568
Mailing Address - Country:US
Mailing Address - Phone:512-371-7400
Mailing Address - Fax:512-371-7488
Practice Address - Street 1:8229 SHOAL CREEK BLVD
Practice Address - Street 2:SUITE#101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-7568
Practice Address - Country:US
Practice Address - Phone:512-371-7400
Practice Address - Fax:512-371-7488
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG5089207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB58938Medicare UPIN
TX00U71RMedicare ID - Type Unspecified