Provider Demographics
NPI:1144424144
Name:FIDLER, RICHARD LEE II (CRNA, CRNP, MSN)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEE
Last Name:FIDLER
Suffix:II
Gender:M
Credentials:CRNA, CRNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:182 STANYAN ST
Mailing Address - Street 2:APT #1
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-4268
Mailing Address - Country:US
Mailing Address - Phone:804-306-4806
Mailing Address - Fax:
Practice Address - Street 1:4150 CLEMENT ST
Practice Address - Street 2:BLDG 6 DEPT OF ANESTHESIOLOGY, ROOM 201
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1545
Practice Address - Country:US
Practice Address - Phone:415-221-4810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17255363LA2200X
CA3530367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health