| NPI | 1871853416 |
|---|---|
| Former Name | JAMIE A TIDWELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0059233) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 27603) |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2018-06-28 |