Provider Demographics
NPI:1811283427
Name:FIDALGO, GARRETT M (MD)
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:M
Last Name:FIDALGO
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 1:5420 KIETZKE LN
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-3022
Mailing Address - Country:US
Mailing Address - Phone:775-770-3188
Mailing Address - Fax:775-853-8112
Practice Address - Street 1:235 W 6TH ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4548
Practice Address - Country:US
Practice Address - Phone:775-770-3188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN16307390200000X
NV15261207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program