Doctor Name: | BRETT R TIDWELL |
NPI Number: | 1417210352 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DO |
License Number: | OS13152 |
Business Practice Address: | 27 Mack Bayou Loop Ste 2000 Santa Rosa Beach, FL - 324592613 |
Business Phone Number: | 8502672961 |
Business Fax Number: | 8506225634 |
Mailing Address: | Po Box 2699, Attn: Shmg/hpe PENSACOLA |
State: | FL |
Postal Code: | 325132699 |
Phone Number: | 8502672961 |
Fax Number: | 8506225634 |
NPI Enumeration Date: | 06/15/2012 |
NPI Last Update Date: | 03/14/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207V00000X |
License Number: | OS13152 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Obstetrics & Gynecology |
Taxonomy Specialization: | |
Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |