Provider Demographics
NPI:1417360157
Name:VIDRINE, SAMANTHA LAVERGNE (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:LAVERGNE
Last Name:VIDRINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1268 ATTAKAPAS DR STE 102
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6515
Mailing Address - Country:US
Mailing Address - Phone:337-447-4280
Mailing Address - Fax:337-447-4282
Practice Address - Street 1:1268 ATTAKAPAS DR STE 102
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6515
Practice Address - Country:US
Practice Address - Phone:337-447-4280
Practice Address - Fax:337-447-4282
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLTRN20049207V00000X
LA310423207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology