Individual
DUSTIN VIDRINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 CITYWEST BLVD, STE. 300, HOUSTON, TX 77042-2300
(972) 233-1999
(972) 233-3666
Mailing address
PO BOX 650865, DALLAS, TX 75265-0865
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP115519
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
187060202
—
TX
05
—
187060203
—
TX
05
—
187060205
—
TX
01
—
75-1976930-005
TRICARE
TX
01
—
8330UE
BCBS
TX
01
—
8694UM
BCBS
TX
01
—
P01246272
RAIL ROAD
TX
Enumeration date
01/03/2007
Last updated
02/16/2017
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