Individual
MR. LARRY E. TIDYMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1313 N CHEYENNE ST, BENKELMAN, NE 69021-3074
(308) 423-2151
(308) 423-2217
Mailing address
PO BOX 710, BENKELMAN, NE 69021-0710
(308) 423-2151
(308) 423-2217
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
343
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2287458901
—
KS
01
—
37814
BCBS OF NE
NE
Enumeration date
10/06/2006
Last updated
09/01/2010
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