Provider Demographics
NPI:1376557223
Name:NAZARIO-VIDAL, URIEL (MD)
Entity Type:Individual
Prefix:
First Name:URIEL
Middle Name:
Last Name:NAZARIO-VIDAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:786-522-9077
Practice Address - Street 1:1786 BLANDING BLVD STE 3
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-3804
Practice Address - Country:US
Practice Address - Phone:904-282-8000
Practice Address - Fax:904-282-8044
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76044207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44434YMedicare ID - Type Unspecified
FLG80399Medicare UPIN