NPI | 1053957456 |
---|---|
Entity Type | Organization |
Authorized Contact | WILLIAM TIDWELL Owner/Physician 270-933-2109 |
Organization Subpart ? | No |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
Enumeration Date | 2019-11-20 |
Last Update Date | 2020-03-27 |