Tidwell, Justin Alan

Tidwell, Justin Alan is an sole proprietor health care provider with primary practice located at 501 N Graham St Suite 415, Portland OR 97227-1654. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as his primary health care specialty. Tidwell, Justin Alan can be contacted via phone (503) 413-2005.

Contact Information

Primary practice address
501 N Graham St Suite 415 Portland OR 97227-1654
Phone: (503) 413-2005
Fax: (503) 413-3699
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X PO00000806 Washington
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X DP00373 Oregon

Profile Details

NPI number 1710908892
LBN Legal business name Tidwell, Justin Alan
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 22nd, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Popular Providers