Individual
GREGORY VIDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
7945 WOLF RIVER BLVD, GERMANTOWN, TN 38138-1762
(901) 683-0055
(901) 685-2969
Mailing address
7714 POPLAR AVE STE 200, GERMANTOWN, TN 38138-3941
(901) 683-0055
(901) 922-6722
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
23969
MS
207RX0202X
Medical Oncology Physician
Primary
51775
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00457534
—
MS
05
—
209870001
—
AR
05
—
Q008640
—
TN
Enumeration date
03/16/2010
Last updated
11/08/2017
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