Provider Demographics
NPI:1811996622
Name:FIEDLER II, ALBERT E II (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:E
Last Name:FIEDLER II
Suffix:II
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 1:3900 S ZINTEL WAY
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-942-2268
Practice Address - Street 1:336 CHARDONNAY AVE BLDG 2
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350
Practice Address - Country:US
Practice Address - Phone:509-942-3627
Practice Address - Fax:509-628-8335
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2013-09-25
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-05-23
Provider Licenses
StateLicense IDTaxonomies
WAMD00027402207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0273285OtherLABOR & INDUSTRIES
WA8117582Medicaid
WAA51940Medicare UPIN
WA8899187Medicare PIN
WAAB06523Medicare ID - Type Unspecified