Organization
CHERYL C. TIDBALL DO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHERYL C. TIDBALL D.O. (PHYSICIAN)
(503) 489-0663
Entity
Organization
Contact information
Practice address
1217 NE BURNSIDE RD, SUITE 101, GRESHAM, OR 97030-6722
(503) 489-0663
(503) 666-5644
Mailing address
1217 NE BURNSIDE RD, SUITE 101, GRESHAM, OR 97030-6722
(503) 489-0663
(503) 666-5644
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
DO19432
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203778
—
OR
Enumeration date
05/07/2007
Last updated
08/22/2020
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