Basic Information
| Provider Information | |||||||||
| NPI: | 1689643637 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FIDLER | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12187 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309142187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068639595 | ||||||||
| FaxNumber: | 7068688375 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 COIT RD STE 305 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750756172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068639595 | ||||||||
| FaxNumber: | 7068688375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 04/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | R8186 | TX | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | 0101273072 | VA | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | 10838A | WY | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | ME152606 | FL | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | CDRH.0055039 | CO | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | MC-0432 | ID | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | 73960 | GA | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | 27572 | MS | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | 19524 | NV | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | MD0000064204 | TN | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | R8186 | TX | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
No ID Information.