Provider Demographics
NPI:1851355580
Name:OLIVER-VIDAUD, RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:OLIVER-VIDAUD
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 1:3070 SW 121ST AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-1318
Mailing Address - Country:US
Mailing Address - Phone:954-382-1782
Mailing Address - Fax:954-382-1989
Practice Address - Street 1:1445 NW BOCA RATON BLVD
Practice Address - Street 2:AKER KASTEN CATARACT & LASER INSTITUTE
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1610
Practice Address - Country:US
Practice Address - Phone:561-338-7722
Practice Address - Fax:561-338-7785
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54983207L00000X, 207L00000X
NJ25MA04181000207L00000X
NY159571 1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042127800Medicaid
FL042127800Medicaid
FL07958Medicare PIN