| Organization Name: | PAT T.TIDWELL,M.D.,P.A. |
| NPI Number: | 1093086563 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PAT THOMAS TIDWELL (PRESIDENT) |
| Mailing Address: | 1001 College Blvd W Suite A Niceville |
| State: | FL US |
| Postal Code: | 325781099 |
| Phone Number: | 8506786735 |
| Fax Number: | 8506788078 |
| NPI Enumeration Date: | 01/16/2012 |
| NPI Last Update Date: | 01/16/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | ME30890 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |