Provider Demographics
NPI:1356315196
Name:VIDAL, RAMON E (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:E
Last Name:VIDAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 9784
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-0784
Mailing Address - Country:US
Mailing Address - Phone:787-282-3000
Mailing Address - Fax:787-767-2272
Practice Address - Street 1:369 DE DIEGO STREET
Practice Address - Street 2:TORRE SAN FRANCISCO SUITE 508
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-0000
Practice Address - Country:US
Practice Address - Phone:787-282-3000
Practice Address - Fax:787-767-2272
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR8798207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR28798OtherCIGNA
PR9100040OtherHUMANA
PR28798OtherMCS
PR80705OtherTRIPLE-S
PR2725OtherPREFERRED MEDICARE CHOICE
PR8798OtherPHYSICIAN LICENSE NUMBER
PRC82784Medicare UPIN
PR2725OtherPREFERRED MEDICARE CHOICE