Doctor Name: | DR. STEPHEN J TIDIK |
NPI Number: | 1053306803 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | G57086 |
Business Practice Address: | 77 Casa St Suite 103 San Luis Obispo, CA - 934055803 |
Business Phone Number: | 8055448993 |
Business Fax Number: | 8055440120 |
Mailing Address: | 77 Casa St, Suite 103 SAN LUIS OBISPO |
State: | CA |
Postal Code: | 934055803 |
Phone Number: | 8055448993 |
Fax Number: | 8055440120 |
NPI Enumeration Date: | 09/19/2005 |
NPI Last Update Date: | 06/17/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | G57086 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |