Provider Demographics
NPI:1861497943
Name:VIDAL, JOSEPH ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:VIDAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2403 SE 17TH ST
Mailing Address - Street 2:STE 301
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-2642
Mailing Address - Country:US
Mailing Address - Phone:352-629-8138
Mailing Address - Fax:352-629-7879
Practice Address - Street 1:2403 SE 17TH ST
Practice Address - Street 2:STE 301
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-2642
Practice Address - Country:US
Practice Address - Phone:352-629-8138
Practice Address - Fax:352-629-7879
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME35667207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42141OtherBLUE CROSS
FL42141ZMedicare PIN
FLD62424Medicare UPIN