Individual
JORGE ALBERTO VIDAURRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
555 S 18TH ST, COLUMBUS, OH 43205-2696
(614) 722-6200
Mailing address
555 S 18TH ST, COLUMBUS, OH 43205-2696
(614) 722-2000
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
35087257
OH
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
35087257
OH
2084N0600X
Clinical Neurophysiology Physician
35087257
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0080530
—
OH
01
—
4177661
CGS - MEDICARE
OH
Enumeration date
03/31/2006
Last updated
05/14/2026
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