MEDICARE: DR. JUAN FELIX GAIDO MD

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
1	208000000X	Pediatrics Physician	34761	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174509749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN FELIX GAIDO MD

Provider Business Mailing Address
First Line	:	1058 COLLEGE DRIVE
Second Line	:
City	:	NEW TOWN
State	:	ND
Zip	:	58763
Country	:	US
Telephone Number	:	701-627-4750
Fax Number	:	701-627-3803

Provider Business Practice Location Address
First Line	:	1058 COLLEGE DR
Second Line	:
City	:	NEW TOWN
State	:	ND
Zip	:	58763-9112
Country	:	US
Telephone Number	:	701-627-4750
Fax Number	:	701-627-4750

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	08/04/2014

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