Provider Demographics
NPI:1205333838
Name:VIDRINE, CHARLES REMIE JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:REMIE
Last Name:VIDRINE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:FAMILY MEDICINE ASSOCIATES OF OAKDALE
Mailing Address - Street 2:105 N HOSPITAL DRIVE
Mailing Address - City:OAKDALE
Mailing Address - State:LA
Mailing Address - Zip Code:71463-3034
Mailing Address - Country:US
Mailing Address - Phone:318-335-4321
Mailing Address - Fax:318-335-4908
Practice Address - Street 1:FAMILY MEDICINE ASSOCIATES OF OAKDALE
Practice Address - Street 2:105 N HOSPITAL DRIVE
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463-3034
Practice Address - Country:US
Practice Address - Phone:318-335-4321
Practice Address - Fax:318-335-4908
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2024-04-12
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Provider Licenses
StateLicense IDTaxonomies
LA321216207QH0002X, 208M00000X
LA321213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2150316Medicaid