Individual
ERIC LEE TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5530 1 UNIVERSITY OF NEW MEXICO, ALBUQUERQUE, NM 87131-0001
(505) 272-2269
(505) 272-5821
Mailing address
1 UNIVERSITY OF NEW MEXICO, ALBUQUERQUE, NM 87131-0001
(505) 272-2269
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
010737
AZ
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
NM
Other
Enumeration date
03/30/2022
Last updated
05/03/2024
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