NPI 1265672505

Douglas Tidwell, CCP

Practitioner Perfusionist Kettering, OH

Practice location

Address: 580 Lincoln Park Blvd Suite 322, Kettering, OH 45429-3474
Phone: (937) 297-6800
Fax: (937) 297-6810

Registered specialties

Perfusionist Primary

Technologists, Technicians & Other Technical Service Providers Taxonomy 242T00000X

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Registry record

NPI: 1265672505
Entity type: Individual
Sex (as registered): Male
NPI issued: 26 Feb 2009
Record last updated: 26 Feb 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.