Doctor Name: | JORGE ALBERTO VIDAURRE |
NPI Number: | 1699736165 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 35087257 |
Business Practice Address: | 555 S 18th St Columbus, OH - 432052696 |
Business Phone Number: | 6147224634 |
Business Fax Number: | 6147224633 |
Mailing Address: | 555 S 18th St, COLUMBUS |
State: | OH |
Postal Code: | 432052696 |
Phone Number: | 6147224634 |
Fax Number: | 6147224633 |
NPI Enumeration Date: | 03/31/2006 |
NPI Last Update Date: | 04/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2084A0401X |
License Number: | 35087257 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OH |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Psychiatry & Neurology |
Taxonomy Specialization: | Addiction Medicine |
Taxonomy Definition: | A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |