=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053519421
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOMMY R. TIGAR, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2007
-----------------------------------------------------
Last Update Date | 04/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 341 E. MAIN STREET
-----------------------------------------------------
City | CLARKSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-289-2455
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1150 PRATT RD
-----------------------------------------------------
City | BLANCHESTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45107-8777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-383-0643
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | TOMMY R TIGAR
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 937-289-2455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 35074055T
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------