Healthcare Provider Details

I. General information

NPI: 1710986880
Provider Name (Legal Business Name): ALEX A.S. FIDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 BETHANY LN
SHELBYVILLE TN
37160-3453
US

IV. Provider business mailing address

2819 BLACK STALLION CT
MURFREESBORO TN
37130-3353
US

V. Phone/Fax

Practice location:
  • Phone: 931-684-8029
  • Fax: 931-680-9835
Mailing address:
  • Phone: 615-890-0458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD25776
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: