Individual
MR. CALVIN DALE VIDRINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRA RJ RN
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
Update your record
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