Individual
DR. TYSON JENSEN TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
454 E MEDICAL WAY, HEBER CITY, UT 84032-1391
(435) 657-4400
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(435) 657-4400
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
11271416-1204
UT
208000000X
Pediatrics Physician
R0967
TX
208M00000X
Hospitalist Physician
007623
AZ
Other
Enumeration date
04/28/2014
Last updated
04/26/2022
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