Individual
MR. CALVIN DALE VIDRINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRA RJ RN
Contact information
Practice address
174 GRANT RD, OPELOUSAS, LA 70570-0720
(337) 594-9637
(337) 948-4556
Mailing address
PO BOX 1939, OPELOUSAS, LA 70571-1939
(337) 942-1915
(337) 942-1990
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
10041005
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1664669
—
LA
01
—
2000777340
BCBS
LA
Enumeration date
05/18/2006
Last updated
02/29/2012
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