Individual provider · Type 1 NPI

Justin Alan Tidwell, DPM

Foot & Ankle Surgery Podiatrist · Portland, OR

NPI number 1710908892 Active

Practice location

501 N Graham St, Suite 415
Portland, OR 97227-1654

Call (503) 413-2005 Map

Fax (503) 413-3699

Mailing address

5815 NE 23rd Ave
Portland, OR 97211-5447

Specialties and licenses

TaxonomyCodeLicense
Foot & Ankle Surgery Podiatrist 213ES0103XPO00000806 (WA)
Foot & Ankle Surgery Podiatrist Primary 213ES0103XDP00373 (OR)

Foot & Ankle Surgery Podiatrist: Definition to come...

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About NPI 1710908892

Justin Alan Tidwell, DPM's National Provider Identifier is 1710908892, issued on Jul 22, 2006. The primary taxonomy on file is Foot & Ankle Surgery Podiatrist (213ES0103X), and the practice location is in Portland, OR. The record was last updated on Jul 8, 2007.