Individual
DR. JUSTIN TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
604 INDIANA, LUBBOCK, TX 79415
(806) 775-9700
Mailing address
3804 53RD ST, LUBBOCK, TX 79413-3824
(806) 795-0914
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
L5926
TX
Other
Enumeration date
07/20/2006
Last updated
07/08/2007
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