Individual
DR. JEFFREY W. FIDONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15210 COUNTY ROAD 164, TYLER, TX 75703
(903) 571-1985
Mailing address
15210 COUNTY ROAD 164, TYLER, TX 75703
(903) 571-1985
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
01080093A
IN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
31842
OK
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
H6215
TX
207RP1001X
Pulmonary Disease Physician
H6215
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102165102
—
TX
01
—
290005858
RR MC
TX
Enumeration date
07/12/2005
Last updated
08/01/2019
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