Provider Demographics
NPI:1548602212
Name:VIDOVIC, GREGORY (DPM, DABFAS)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:VIDOVIC
Suffix:
Gender:M
Credentials:DPM, DABFAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 VISION PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3012
Mailing Address - Country:US
Mailing Address - Phone:281-363-2829
Mailing Address - Fax:281-292-1201
Practice Address - Street 1:101 VISION PARK BLVD
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3012
Practice Address - Country:US
Practice Address - Phone:281-363-2829
Practice Address - Fax:281-292-1201
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2223213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery