Provider Demographics
NPI:1326564824
Name:VIDAURRE, ALAN B
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:B
Last Name:VIDAURRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3829 E SHORE RD
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-4957
Mailing Address - Country:US
Mailing Address - Phone:424-208-9761
Mailing Address - Fax:
Practice Address - Street 1:3829 E SHORE RD
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-4957
Practice Address - Country:US
Practice Address - Phone:424-208-9761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other