Healthcare Provider Details

I. General information

NPI: 1053519421
Provider Name (Legal Business Name): TOMMY R. TIGAR, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 E. MAIN STREET
CLARKSVILLE OH
45113
US

IV. Provider business mailing address

1150 PRATT RD
BLANCHESTER OH
45107-8777
US

V. Phone/Fax

Practice location:
  • Phone: 937-289-2455
  • Fax:
Mailing address:
  • Phone: 937-383-0643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35074055T
License Number StateOH

VIII. Authorized Official

Name: TOMMY R TIGAR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 937-289-2455