Provider Demographics
NPI:1720061450
Name:BIDART, CHAD M (MD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:M
Last Name:BIDART
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 1:27 ENGINE CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-8536
Mailing Address - Country:US
Mailing Address - Phone:775-772-1494
Mailing Address - Fax:775-772-1494
Practice Address - Street 1:407 S SCHWARTZ AVE STE 202
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5925
Practice Address - Country:US
Practice Address - Phone:505-609-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12296207RC0000X, 207RC0001X, 207RC0000X
NMMD2019-0474207RC0001X
CAA96140207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODR.0059182OtherMEDICAL LICENSE
NVFB9179412OtherDEA
1720061450OtherNPI
NV12296OtherMEDICAL LICENSE
11028080OtherCAQH
NV1720061450Medicaid
NMFC3433670OtherDEA
NMMD2019-0474OtherMEDICAL LICENSE