Individual
JAMES ELLIOTT TIDWELL III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2211 MAYFAIR DR STE 305, OWENSBORO, KY 42301-4572
(270) 688-3700
(270) 688-3709
Mailing address
PO BOX 23229, OWENSBORO, KY 42304-3229
(270) 688-1330
(270) 688-1338
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
47992
KY
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
47992
KY
Other
Enumeration date
04/19/2007
Last updated
07/01/2021
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