Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | L2728 | TX |
NPI | 1073560199 |
---|---|
Provider Name | Alex C Vidaeff |
First Address | Houston, TX 77216-1088 |
Second Address | Houston, TX 77030-2351 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 03/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
150664401 | (05) | TX |
8A4436 | BCBS (01) | TX |
F74757 | (02) |