Healthcare Provider Details

I. General information

NPI: 1497243497
Provider Name (Legal Business Name): GAVIN FIDDLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 CHERRY ST ACC 305
TOLEDO OH
43608
US

IV. Provider business mailing address

2213 CHERRY ST ACC 305
TOLEDO OH
43608
US

V. Phone/Fax

Practice location:
  • Phone: 419-251-4546
  • Fax: 419-251-0442
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number2023-00584
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR76654
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.154320
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2023-00584
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: