Provider Demographics
NPI:1477546075
Name:VIDAL, JOSE FRANCISCO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:FRANCISCO
Last Name: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 1:8109 FREDERICKSBURG RD
Mailing Address - Street 2:PHYSICIAN PRACTICE SERVICES
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3311
Mailing Address - Country:US
Mailing Address - Phone:210-575-8229
Mailing Address - Fax:210-575-8127
Practice Address - Street 1:8026 FLOYD CURL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3915
Practice Address - Country:US
Practice Address - Phone:210-575-8229
Practice Address - Fax:210-575-8127
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2013-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL41582084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172066604Medicaid
TX8DJ871OtherBCBS
TXP00951171OtherRAILROAD
TX172066602Medicaid
TX172066605Medicaid
8CU839OtherBCBS TX
8CU839OtherBCBS TX
TXTXB158410Medicare PIN
TX172066605Medicaid
TXB130156Medicare PIN