Healthcare Provider Details

I. General information

NPI: 1972131696
Provider Name (Legal Business Name): HENRY FIDLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5232 EL CLARO CIR
WEST PALM BEACH FL
33415-2773
US

IV. Provider business mailing address

5232 EL CLARO CIR
WEST PALM BEACH FL
33415-2773
US

V. Phone/Fax

Practice location:
  • Phone: 561-909-7632
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11013492
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: