Provider Demographics
NPI:1578822185
Name:CARLOS VIDALON, M.D., P.A.
Entity Type:Organization
Organization Name:CARLOS VIDALON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:VIDALON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-625-6778
Mailing Address - Street 1:201 NW 82ND AVE
Mailing Address - Street 2:SUITE 504
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7808
Mailing Address - Country:US
Mailing Address - Phone:954-625-6778
Mailing Address - Fax:954-625-6780
Practice Address - Street 1:201 NW 82ND AVE
Practice Address - Street 2:SUITE 504
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7808
Practice Address - Country:US
Practice Address - Phone:954-625-6778
Practice Address - Fax:954-625-6780
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARLOS VIDALON, M.D,, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0021572207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1760480156OtherNPI