Provider Demographics
NPI:1699200535
Name:FIRDOUS, NIDA (MD)
Entity Type:Individual
Prefix:MRS
First Name:NIDA
Middle Name:
Last Name:FIRDOUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W 16TH ST # 105
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2781
Mailing Address - Country:US
Mailing Address - Phone:719-584-4000
Mailing Address - Fax:
Practice Address - Street 1:400 W 16TH ST # 105
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2781
Practice Address - Country:US
Practice Address - Phone:719-584-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2020-07-03
Deactivation Date:2017-12-04
Deactivation Code:
Reactivation Date:2017-12-13
Provider Licenses
StateLicense IDTaxonomies
CODR0064812207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine