Provider Demographics
NPI:1720277288
Name:GIDOR, MARY JOAN D (MD)
Entity Type:Individual
Prefix:
First Name:MARY JOAN
Middle Name:D
Last Name:GIDOR
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 1:50249 CESAR CHAVEZ ST STE K
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-1530
Mailing Address - Country:US
Mailing Address - Phone:760-393-0555
Mailing Address - Fax:760-393-0522
Practice Address - Street 1:50249 CESAR CHAVEZ ST STE K
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1530
Practice Address - Country:US
Practice Address - Phone:760-393-0555
Practice Address - Fax:760-393-0522
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113398208000000X
PAMD447147208000000X
CAC177140208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics