Individual
JOHN SCOTT TIDBALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
23415 THREE NOTCH RD, SUITE 2054 WILDEWOOD CENTER, CALIFORNIA, MD 20619-4017
(301) 737-7833
(301) 737-4865
Mailing address
23415 THREE NOTCH RD, SUITE 2054, CALIFORNIA, MD 20619-4017
(301) 737-7833
(301) 737-4865
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D52196
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1389505000
—
MD
Enumeration date
09/20/2006
Last updated
04/18/2011
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