Provider Demographics
NPI:1689632697
Name:DESPRADEL, VIDAL MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:VIDAL
Middle Name:MANUEL
Last Name:DESPRADEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 E SHEA BLVD STE 5140
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5499
Mailing Address - Country:US
Mailing Address - Phone:480-301-8000
Mailing Address - Fax:864-716-6120
Practice Address - Street 1:13400 E SHEA BLVD STE 5140
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-5499
Practice Address - Country:US
Practice Address - Phone:480-301-8000
Practice Address - Fax:864-716-6120
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2024-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29560208800000X
VA0101058950208800000X
AZ73947208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC295601Medicaid
SCP01121076OtherRR MEDICARE
SC295601Medicaid
SCP01121076OtherRR MEDICARE