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NPI Code Detail

MEDICARE: BRYAN FIDLER

MEDICARE: BRYAN FIDLER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1932880424
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRYAN FIDLER
Provider Business Mailing Address
First Line : 4245 S GRAND CANYON DR STE 226
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-7162
Country : US
Telephone Number : 702-751-0356
Fax Number :
Provider Business Practice Location Address
First Line : 3441 W SAHARA AVE STE C1
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-6059
Country : US
Telephone Number : 702-751-0356
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2023
Last Update Date : 02/17/2026

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Directions to “ BRYAN FIDLER ” Practice Location

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