Provider Demographics
NPI:1639328248
Name:VIDAL, YAEL (MD)
Entity Type:Individual
Prefix:MRS
First Name:YAEL
Middle Name:
Last Name:VIDAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 DONALD ROSS RD
Mailing Address - Street 2:
Mailing Address - City:JUNO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-1606
Mailing Address - Country:US
Mailing Address - Phone:561-543-0808
Mailing Address - Fax:561-781-9507
Practice Address - Street 1:871 DONALD ROSS RD
Practice Address - Street 2:
Practice Address - City:JUNO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-1606
Practice Address - Country:US
Practice Address - Phone:561-543-0808
Practice Address - Fax:561-781-9507
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126842207R00000X
NJ25MA08920700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMF6Y8OtherFLORIDA BLUE
FL018699000Medicaid
FL018699000Medicaid