Organization
RICHARD H TIDWELL MD PLLC
Active
Other names
Jay Family Medicine Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD H TIDWELL MD (OWNER)
(918) 253-2550
Entity
Organization
Contact information
Practice address
2485 N MAIN STREET, JAY, OK 74346-0987
(918) 253-2550
(918) 253-2559
Mailing address
PO BOX 987, JAY, OK 74346-0987
(918) 253-2550
(918) 253-2559
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18708
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
442760537004
BLUE CROSS BLUE SHIELD
OK
Enumeration date
01/30/2007
Last updated
04/20/2008
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