Provider Demographics
NPI:1710986880
Name:FIDER, ALEX AS (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:AS
Last Name:FIDER
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 1:2819 BLACK STALLION CT
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3353
Mailing Address - Country:US
Mailing Address - Phone:615-890-0458
Mailing Address - Fax:
Practice Address - Street 1:319 BETHANY LN
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-3453
Practice Address - Country:US
Practice Address - Phone:931-684-8029
Practice Address - Fax:931-680-9835
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD257762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3810850Medicaid
TN3074808OtherBC-BS PROVIDER NUMBER
TNF72732Medicare UPIN
TN3810850Medicare ID - Type UnspecifiedPROVIDER NUMBER