Basic Information
| Provider Information | |||||||||
| NPI: | 1366873903 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DOCTORS ANESTHESIA TIDWELL PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9103 ROCKCLIFF DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770372231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812495954 | ||||||||
| FaxNumber: | 2816055792 | ||||||||
| Practice Location | |||||||||
| Address1: | 5010 WEST TIDWELL RD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816188500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2013 | ||||||||
| LastUpdateDate: | 01/22/2014 | ||||||||
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| AuthorizedOfficialLastName: | AMIN-SANKAR | ||||||||
| AuthorizedOfficialFirstName: | ZATUL | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2812495954 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.