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Organization
PAT T. TIDWELL MD PA
Active
Organization
PAT T. TIDWELL MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAT THOMAS TIDWELL SR. M.D. (PRESIDENT)
(850) 678-6735
Entity
Organization
Contact information
Practice address
4554 HIGHWAY 20 EAST, NICEVILLE, FL 32578
(850) 678-6735
(850) 678-8078
Mailing address
4554 HIGHWAY 20 EAST, NICEVILLE, FL 32578
(850) 678-6735
(850) 678-8078
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QH0100X
Health Service Clinic/Center
ME30890
FL
Other
Enumeration date
01/16/2012
Last updated
12/12/2018
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