Individual
DR. CLIFFORD RANDOLPH TILLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
107 FRONT ST, SUITE 2126, VIDALIA, LA 71373-2836
(318) 336-2216
(318) 336-6074
Mailing address
107 FRONT ST, SUITE 2126, VIDALIA, LA 71373-2836
(318) 336-2216
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
06980R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0115585
—
MS
05
—
1316521
—
LA
Enumeration date
10/07/2005
Last updated
07/25/2008
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