Provider Demographics
NPI:1891783932
Name:VIDAL, CARLOS A (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:VIDAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1321 NW 14TH ST
Mailing Address - Street 2:STE. 601
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1673
Mailing Address - Country:US
Mailing Address - Phone:305-325-1700
Mailing Address - Fax:305-325-9603
Practice Address - Street 1:1321 NW 14TH ST
Practice Address - Street 2:STE. 601
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1673
Practice Address - Country:US
Practice Address - Phone:305-325-1700
Practice Address - Fax:305-325-9603
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2008-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0074029207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42264VMedicare PIN
G64883Medicare UPIN