Provider Demographics
NPI:1174509749
Name:GAIDO, JUAN FELIX (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:FELIX
Last Name:GAIDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 COLLEGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW TOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58763
Mailing Address - Country:US
Mailing Address - Phone:701-627-4750
Mailing Address - Fax:701-627-3803
Practice Address - Street 1:1058 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:NEW TOWN
Practice Address - State:ND
Practice Address - Zip Code:58763-9112
Practice Address - Country:US
Practice Address - Phone:701-627-4750
Practice Address - Fax:701-627-4750
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34761208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND17742Medicaid
CO01347616Medicaid
CO01347616Medicaid
COC54344Medicare PIN