Pat T. Tidwell MD PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PAT T. TIDWELL MD PA

Practice address

4554 Highway 20 East
Niceville, FL 32578

Phone

(850) 678-6735

Fax

(850) 678-8078

NPI assigned

Jan 16, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Pat Thomas Tidwell Sr., M.D.

Title

President

Phone

(850) 678-6735

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1326672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544572800000",
    "number": "1093086563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4554 HIGHWAY 20 EAST",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "32578",
            "telephone_number": "850-678-6735",
            "fax_number": "850-678-8078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4554 HIGHWAY 20 EAST",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "32578",
            "telephone_number": "850-678-6735",
            "fax_number": "850-678-8078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAT T. TIDWELL MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-16",
        "last_updated": "2018-12-12",
        "status": "A",
        "authorized_official_last_name": "TIDWELL",
        "authorized_official_first_name": "PAT",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-678-6735",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "FL",
            "license": "ME30890",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela Ottesen DMD LLC
• Rachel Parden
• Danielle Parisi, COTA/L
• Partin Place Operations, LLC
• Kaitlyn Partin
• Angela Pate, PHARM D
• Regina A Patton, PT
• Emily Lee Paulson
• Janet L Paulus, SOCIAL WORKER
• Elaine Peacock

• Family Medicine Physician in Niceville, FL
• Providers in Niceville, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.