Individual
JOHN PAUL VIDOLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
836 SUNSET LAKE BLVD, SUITE 102, VENICE, FL 34292-7554
(941) 497-1771
(941) 497-1860
Mailing address
836 SUNSET LAKE BLVD, SUITE 102, VENICE, FL 34292-7554
(941) 497-1771
(941) 497-1860
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
ME0068375
FL
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
ME0068375
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27192
BCBS
FL
01
—
27192Z
MEDICARE PROVIDER
FL
01
—
3925180001
PALMETTO GBA
—
Enumeration date
11/07/2005
Last updated
11/16/2007
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