Provider Demographics
NPI:1780779967
Name:JOSEPH VIDAL MD PA
Entity type:Organization
Organization Name:JOSEPH VIDAL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:VIDAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-629-8138
Mailing Address - Street 1:2403 SE 17TH ST
Mailing Address - Street 2:#301
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-9184
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:#301
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-9184
Practice Address - Country:US
Practice Address - Phone:352-629-8138
Practice Address - Fax:352-629-7879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0035667207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH976Medicare PIN
FLD62424Medicare UPIN