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General NPI Number Information
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NPI Number | 1043406838
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Entity Type | Organization
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Legal Business Name | VEIN SPECIALISTS, P.A.
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Dates
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Enumeration Date | 09/14/2007
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Last Update Date | 04/02/2020
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Provider Practice Location Address
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Address Line | 5155 CORPORATE WAY STE A
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City | JUPITER
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State | FL
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Zip | 33458-4359
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Country | US
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Telephone | 561-624-0123
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Fax | 561-624-1453
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Provider Business Mailing Address
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Address Line | 5155 CORPORATE WAY STE A
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City | JUPITER
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State | FL
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Zip | 33458-4359
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Country | US
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Telephone | 561-624-0123
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Fax | 561-624-1453
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN M. TIDWELL
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Credential | M.D.
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Telephone | 561-624-0123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | ME 62477
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License Number State | FL
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