Individual
DR. HOLLIS TIDMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1422 S SAM HOUSTON BLVD, HOUSTON, MO 65483-2130
(417) 967-1252
(417) 967-0417
Mailing address
1422 S SAM HOUSTON BLVD, HOUSTON, MO 65483-2130
(417) 967-1252
(417) 967-0417
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2009005897
MO
2086S0127X
Trauma Surgery Physician
2009005897
MO
2086S0129X
Vascular Surgery Physician
2009005897
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207050501
—
MO
Enumeration date
01/28/2006
Last updated
01/31/2023
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