MEDICARE: DR. PHILIP E FIDLER M.D.

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	2086S0102X	Surgical Critical Care Physician	19524	NV
2	2086S0102X	Surgical Critical Care Physician	R8186	TX
3	2086S0102X	Surgical Critical Care Physician	0101273072	VA
4	2086S0102X	Surgical Critical Care Physician	10838A	WY
5	2086S0102X	Surgical Critical Care Physician	ME152606	FL
6	2086S0102X	Surgical Critical Care Physician	CDRH.0055039	CO
7	2086S0102X	Surgical Critical Care Physician	MD0000064204	TN
8	2086S0102X	Surgical Critical Care Physician	MC-0432	ID
9	2086S0102X	Surgical Critical Care Physician	73960	GA
10	2086S0102X	Surgical Critical Care Physician	27572	MS
11	208600000X	Surgery Physician	R8186	TX

General Provider Information

NPI Number	:	1689643637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP E FIDLER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 12187
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30914-2187
Country	:	US
Telephone Number	:	706-863-9595
Fax Number	:	706-868-8375

Provider Business Practice Location Address
First Line	:	1600 COIT RD STE 305
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-6172
Country	:	US
Telephone Number	:	706-863-9595
Fax Number	:	706-868-8375

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	05/29/2025

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