Provider Demographics
NPI:1780605345
Name:VIDAL, JESUS MIGUEL (MD)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:MIGUEL
Last Name:VIDAL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:ST. 46 SW #1410
Mailing Address - Street 2:LA RIVIERA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921
Mailing Address - Country:US
Mailing Address - Phone:787-739-7846
Mailing Address - Fax:787-653-3112
Practice Address - Street 1:HOSPITAL HIMA SAN PABLO CAGUAS
Practice Address - Street 2:AVE LUIS MUNOZ MARIN
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-653-3434
Practice Address - Fax:787-653-3112
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-02-04
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Provider Licenses
StateLicense IDTaxonomies
PR9192207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8-3244OtherSSS
PRE81604Medicare UPIN
PR8-3244OtherSSS