Individual
BENJAMIN VIDALIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
465 SAINT MICHAELS DR STE 107, SANTA FE, NM 87505-7690
(505) 988-3233
(505) 988-3562
Mailing address
MSC 10 5615, UNIVERSITY OF NEW MEXICO, ALBUQUERQUE, NM 87131-0001
(505) 272-3160
(505) 272-9427
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
MD2021-0303
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
NM
Other
Enumeration date
04/14/2014
Last updated
09/21/2021
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