Individual
JOSE VIDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5955 PONCE DE LEON BLVD, CORAL GABLES, FL 33146
(305) 661-1515
(305) 662-3723
Mailing address
5955 PONCE DE LEON BLVD., CORAL GABLES, FL 33146
(305) 661-1515
(305) 662-3723
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
063816
NJ
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
ME80877
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
279761500
—
FL
05
—
7973403
—
NJ
Enumeration date
07/31/2006
Last updated
10/17/2011
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